THE PROPAGANDA FOR REFORM - IN - Proprietary Medicines Part I. - - - - Council Reports Part II. - - Laboratory Contributions Part III. - - - Miscellaneous Nostrums Part TV. - - - - - Miscellany [Seventh Edition] . / REPRINTED FROM THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION PREFACE TO THE SIXTH EDITION In February;, 1905, the Council on Pharmacy and Chemistry of the American Medical Association was organized to investigate the proprietary medicine ques- tion and to pass on those which should be up to the standard required of ethical proprietary medicines. From time to time reports, of this Council have appeared in the columns of The JquRNAL of the American Medi- cal Association, and The Journal has also contained other matter relating to the question of nostrums and proprietary medicines not. directly connected with the work of the Council. Requests have been received repeatedly for this or that number of The Journal. containing an article on the subject, and, as it has been impossible to furnish many of the copies asked for, it has been thought best to collect some of the matter and issue it in this reprint form. The matter is reprinted from The Journal, either in full or in abstract, and the date on which the original article appeared is given. PREFACE TO THE SEVENTH EDITION The present edition has been compiled on slightly dif- ferent principles from its predecessors. The work of The Journal and of the Association's laboratory was at first confined almost entirely to the criticism and analysis of the so-called ethical proprietaries. And rightly so. The medical profession could not consistently criticise the "patent medicine" evil so long as its own members were prescribing nostrums that were as un- scientific and as secret as the average "patent medicine." It was incumbent on the profession to clean its own back yard before calling attention to the disreputableness of the yards of its neighbors. As the more flagrant evils of the ethical proprietary question have been mitigated or abolished, the Associa- tion has turned the search-light on the more widespread "patent medicine" evil. Of necessity, most of the articles devoted to "patent medicines" or quackery are of greater interest to the general public than they are to the medical profession. The result has been that the number of inquiries from laymen regarding various nostrums and quacks has been steadily increasing. It has been thought best, therefore, to publish in a separate book all of the matter that has appeared in the Propaganda for Reform department of The Journal relative to quackery and to those nostrums exploited only-or chiefly-to the public. This has been done, and the result is the book "Nos- trums and Quackery." The present edition of The Propaganda for Reform contains, therefore, practically none of the matter that is of direct interest to the lay- man. In one or two cases in which there seems to have been an "overlapping," matter that has already appeared in "Nostrums and Quackery" is also given here. As a general rule, however, the matter for the seventh edition of the Propaganda for Reform is of strictly medical interest. Those physicians who are desirous, therefore, of obtaining in convenient form the matter dealing with "patent medicines" should order the book "Nos- trums and Quackery." TABLE OF CONTENTS PART I: COUNCIL REPORTS PAGE Acetanilid Mixtures 9 Anasarcin and Anedemin 11 Cactus Grandiflorus 19 Campho-Phenique 24 Compressed Oxygen 27 Curare 28 Diastase Ferments 31 Echinacea 38 Erpiol (Dr. Schrader) 41 False Unicorn (Helonias) 42 Formurol 42 Gardner's Syrup of Hydriodic Acid 45 Glycozone 49 Labordine 51 Lactopoptine 53 Liquid Nitrous Oxid 55 Meat and Beef Juices 58 Migrainin 64 Oxychlorine 66 Pantopon 68 Papayans (Bell) .. 70 Passiflora and Daniel's Concentrated Tincture of Passiflora.... 74 Pepsin and Pancreatin 76 Phenol- Sodique (Hance Bros. & White) 76 Succus Alterans 79 Quinin Arsenate 81 Strychnin Arsenate 81 Sulpho-Lythin 82 Tyree's Antiseptic Powder 84 Unicorn Root, Wild Yam and Wild Indigo 86 Thialion 87 Vin Mariani 89 Waterbury's Metabolized Cod-Liver Oil Compound 91 PART II: LABORATORY CONTRIBUTIONS Anusol Hemorrhoidal Suppositories 95 Aromatic Digestive Tablets 97 Burnham's Soluble lodin 102 Hydrocyanate of Iron-Tilden 103 Hymosa 106 Liquid Life 109 Micajah's Medicated Uterine Wafers 112 Noitol and Anadol 117 Oxygenor King 119 Saliodin 125 Tablets of Bismuth, Opium and Phenol 127 Unguentine 134 Uricedin - 136 Uriseptin 137 Zemacol 140 Zyme-oid 142 8 CONTENTS PART III : MISCELLANEOUS NOSTRUMS PAGE Alleotone 145 Antikamnia 148 Aspiro-Lithine 157 Benetol 158 Bromidia 160 Bromin-Iodin Compound 1G2 Buffalo Lithia Water 163 Calmine 165 Camphenol 166 Capudine 166 Daniel's Concentrated Tincture of Passiflora Incarnata 170 Dekofa 171 Ecthol 174 Enteronol 174 Glyco-Thymoline 180 Gonococcide 181 Headache Cures 182 Hydronaphthol 185 Hydrozone and Tongaline 186 lodonucleoid 187 Iridium 189 Iron Tropon 190 Jaroma 191 Kutnow's Powder 194 Manola 197 Marienbad Tablets 202 Mercol 203 Narkine 204 Oxidaze-Oleozone-Hydrocine 205 Papine 223 Pas-Avena 225 Pepto-Mangan (Gude) 226 Phenalgin 227 Pheno-Bromate 233 Phenolphthalein 234 Resinol 239 Salacetin 239 Sal-Codeia (Bell) 241 Sal Hepatica 242 Sanatogen-Its Food Value 243 Syrup of Cocillana Compound 245 Tartarlithine 246 Toxicity of the Arylarsonates 247 Tuberculoids 251 Vapo-Cresolene 252 Vasogen and lodovasogen 253 PART IV: MISCELLANY Calcium Chlorophosphate 254 The International Encyclopedia of Ethical Non-Oflicial Phar- maceuticals 255 Meat Extracts and Meat Juices 258 Pernicious Ready-Made Mixtures 262 Pharmaceutical Manufacturers and the Great American Fraud.. 263 Sour Milk Therapy '. . . . 265 THE PROPAGANDA FOR REFORM IN PROPRIETARY MEDICINES PART I COUNCIL REPORTS ACETANILID MIXTURES Report of the Council on Pharmacy and Chemistry To the Council on Pharmacy and Chemistry: In response to the request of your chairman we have investi- gated the below-mentioned preparations and report as follows: Specimens of the articles were bought in different cities in the open market, and in original sealed packages, and were analyzed by some of us or under our direction. Each article was examined by at least two chemists, and some were sub- jected to several analyses. While certain of the preparations are represented as being chemical compounds, the specimens examined were all found to be mixtures; the principal ingredi- ent being acetanilid. The percentage proportions of acetanilid given below are the minimum obtained by any of the analysts. Soda and ammonia, combined with carbonic acid, are calcu- lated and reported as sodium bicarbonate and as ammonium carbonate (U. S. P.) respectively. Salicylic acid is calculated and reported as sodium salicylate. Diluents and other con- stituents than those reported were not determined. A.MMONOL According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given: Acetanilid. Sodium Bicarb. Ammonium Carb. 50. 25. 20. ANTIKAMNIA According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, 10 PROPAGANDA FOR REFORM and to contain the following ingredients approximately in the proportions given: Acetanilid Caffein Citric Acid Sodium Bicarb. 68. 5. 5. 20. KOEHLER'S HEADACHE POWDERS According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given: Acetanilid Caffein 76. 22 ORANGEINE According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given: Acetanilid Sodium Bicarb. Caffein 43. 18. 10. Other constituents said to be present were not determined. PHEN ALGIN According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given: Acetanilid Sodium Bicarb. Ammonium Carb. 57. 29. 10. Certain packages of phenalgin were purchased which on analysis did not show ammonium carbonate. SALACETIN According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given: Acetanilid Sodium Bicarb. Sodium Salicylate 43. 21. 20. We recommend that this report he printed in The Journal of the American Medical Association. Respectfully submitted. J. H. Long, M.S., Sc.D., W. A. PUCKNER, Ph.G. S. P. Sadtler, Ph.D., J. Stieglitz, Ph.D., H. W. Wiley, M.D., Ph.D., Committee on Chemistry, Council on Pharmacy and Chemistry of the A. M. A. (From The Journal .4. M. A., June 3, 1905.) COUNCIL REPORTS 11 ANASARCIN AND ANEDEMIN Reports of the Council on Pharmacy and Chemistry and Coni- ments Thereon (From The Journal A. M. A., May 4 and 11, 1907, pp. 1535, and 1641.) The following reports were submitted to the Council by the subcommittee to which these articles were assigned: ANASARCIN To the Council on Pharmacy and Chemistry:-Your subcom- mittee to whom Anasarcin (Anasarcin Chemical Co., Winches- ter, Tenn.) was assigned, herewith submits its report: This remedy is offered in two forms: "Anasarcin Tablets," a pretended combination of the active principles of oxydendron arboreum, sambucus canadensis, and urginea scilla; and "Ana- sarcin Elixir," said to contain the active principles of oxyden- dron, sambucus, hepatica and potassium nitrate. The adver- tisements of these articles conflict with the rules of the Coun- cil as follows: With Rules 1 and 2: The composition of these articles is kept secret, in that the proportion of the ingredients is not furnished. The statement that it contains the "active prin- ciples" is misleading, since these are for the most part un- known. With Rule 6: The description of the pharmacologic action of Anasarcin agrees practically with that of squill. No mate- rial part of its effects can be attributed to the other ingredi- ents. Nevertheless, the advertisement studiously cultivates the impression that Anasarcin has no relation whatever to the digitalis group in which scilla is commonly placed. The claims are therefore misleading. The claim of its infinite superiority to digitalis, the claims that it cures neurasthenia, eliminates uric acid in rheumatism, and is useful in obesity, cystitis, lum- bago and eclampsia, dyspepsia and asthma, and that it works wonders in exophthalmic goiter, appear exaggerated or false. The recommendation of its indiscriminate use in nephritis, for lowering the blood-pressure and the statement (contra- dicted in the firm's own literature) that it is not depressing are actually dangerous. It is recommended that the articles be refused recognition, and that the report, with explanations, be published. ANEDEMIN To the Council:-Your subcommittee to whom Anedemin (Anedemin Chemical Co., Winchester, Tenn.) was assigned herewith submits its report: Anedemin is an evident imitation of Anasarcin. It is mark- eted as tablets, said to contain the isolated active principles of strophanthus, apocynum, squill and sambucus-chemically 12 PROPAGANDA FOR REFORM combined. The quantities are not stated. The therapeutic claims are copied almost literally from the Anasarcin circulars and are equally false. Anedemin, therefore, conflicts with Rules 1, 5, 6 and 7. It is recommended that this report be published, with com- ments. The reports were adopted by the Council and are herewith published. W. A. Puckner, Secretary. Anasarcin This wonderful remedy, Anasarcin, has already been exposed in these columns (The Journal A. M. A., Jan. 27, 1906), but it deserves additional mention, as it teaches several important lessons of general application. It is a typical example of the revival, under a new name and a thin disguise, of an old, time- worn article, squill, presumably because experience has demon- strated its general inferiority to other drugs. Anasarcin fur- ther illustrates the dangers involved in the use of semi-secret nostrums. It also shows how a short experience with a widely advertised but little understood drug is apt to lead to conclu- sions which more extensive experience demonstrates to be entirely fallacious. The first lesson is, that formulas are not always what they seem. A hasty glance at the formula of Anasarcin tablets, the basis of the Anasarcin dropsy cure, creates the impression that it is a non-secret remedy; for it is said to represent a combina- tion of the active principles of oxydendron, sambucus and scilla. As a matter of fact, it is a secret nostrum of the insidious kind. A formula which omits the quantities of its potent ingredients means very little. Further than this, we do not hesitate to charge that the claimed composition is a delib- erate deception. The circulars emphasize the claim that Ana- sarcin consists of the isolated principles, and not of the crude drugs. Now, the isolated active principles of sambucus and oxydendron are not on the market, for the good and sufficient reason that no active principles have ever been isolated. Are we to believe that the Anasarcin Company has surpassed the accredited chemists and has discovered such principles and is isolating them? We shall have more to say on this subject presently; but any one in the least familiar with the difficul- ties attending the isolation of organic principles knows such an idea to be preposterous. Indeed, it is absolutely incompati- ble with the exhibition of ignorance of the elementary facts of pharmaceutical chemistry which is given by these people when COUNCIL REPORTS 13 they call the active principles of digitalis and squill "alka- loids." It is an axiom that the effects of a mixture can only be understood if the action of its components are known. So far as we know, the physiologic effects of oxydendron and sam- bucus have never been scientifically investigated, for the sim- ple reason that they are too slight and indefinite to promise results. Both are credited with some slight, obscure diuretic action. Oxydendron, the sour wood or sorrel tree, is a small tree of the heath family, the acid leaves of which are said to be chewed by hunters for their pleasant taste and for the .relief of thirst. Sambucus is the common elder. It is most unlikely that these two innocuous substances should play any part in the claimed powerful effect of Anasarcin; they are evidently put in the formula, we do not say in the preparation, to obscure the fact that Anasarcin is composed principally of squill. That this is so can be gathered unmistakably from a. study of the pharmacologic action of Anasarcin as described by its promoters: Acting primarily on the heart and arterial systems through the nerve ganglia, a natural physiologic balance is established between the arterial and venous systems, whereby effusions . . . are eliminated . . . Coincident with this action there is a note- worthy slowing of the pulse. ... If the remedy is pushed, can be brought down to 20 or 30 beats per minute. ... Its physiological action is to stimulate the cardiac motor-ganglia through the cardiac plexus of the sympathetic system and at the same time exert an inhibitory influence upon the cardiac fibers of the pneumogastric, thereby dilating the arterioles, slowing the heart's action, and increasing the force of the systole. . . . The prolonged diastole allows the ventricle time to completely fill, and the more forcible contraction causes the mitral valve to close more thoroughly and at the same time increases pressure in the coronary arteries, serving thereby the double purpose of relieving pulmo- nary engorgement and increasing heart nutrition. Anasarcin will nauseate some persons. To appreciate fully the meaning of this description of the actions of Anasarcin, it should be compared with the effects of the digitalis group, to which squill belongs. The following account is quoted literally from a recent Text-Book of Phar- macology (Sollmann): The phenomena of the therapeutic stage of digitalis action are said to be: 1. Slowing of the heart, with systole and diastole both lengthened. 14 PROPAGANDA FOR REFORM 2. Increased strength of beat, leading to greater efficiency of the individual contractions, and to an increase in the total efficiency. 3. A tendency to the systolic phase. 4. A rise of blood-pressure, due mainly to the increased action of the heart, but partly also to a vaso-constriction. The therapeutic action may be explained, in part, as follows: A larger amount of blood will be thrown into the aorta and coronary circulation. The first effect will be an improved nutrition of the heart. . . . The tonic action . . . nar- rows the ring of the valves, brings them together, narrows the orifice. . . . The venous congestion will tend to be relieved. This relief . . . will fall in the first place upon the lungs. . . . The lowering of the venous pressure will tend to cause absorption of the effusions. The nauseant action of squill, which is alluded to in connec- tion with Anasarcin, is too well known to require more than a mention. In brief, then, it appears from the statements of the Ana- sarcin Company that the action of the remedy is that of squill and that the other ingredients are a mere blind. It is, of course, well known that squill can be used as a substitute for digitalis in cardiac dropsy, although it is generally considered very inferior to the latter drug. Rose Bradford, for instance, states: "Squill is not used to any extent in the treatment of cardiac disease and cardiac dropsy, digitalis being a far more efficient and less toxic substance." However, it has been fre- quently observed that digitalis occasionally fails, and it may then be replaced successfully by another member of the group. At all events, it is very likely that squill is a fairly efficient substitute for digitalis, especially when it is supplemented by a very free course of Epsom salts and by potassium nitrate (the active ingredient of Anasarcin Elixir), both of which are stated to be essential adjuvants to the Anasarcin (or squill) tablets. There can be no objection to the use of squill when it is indicated; but any one who wishes to use it should do so with his eyes open, knowing what substance he is using and how much (which he does not in Anasarcin) ; knowing also that it has the same indications and limitations as digitalis. He should not be misled by such statements as the following: "Does what dropsy medicaments have hitherto failed to accomplish." "Superior to digitalis, strophanthus, scoparius, squills, acetate of potash and the hydragogue cathartics all put together." "The only known relief [how modest] and permanent cure of dropsies." CO URI GIL RE PORT IS 15 "Unrivaled heart tonic." "The most powerful agent known." Any one wishing to use squill should take the trouble to acquaint himself with the results obtained by competent and independent observers, and not rely on it in eclampsia, septi- cemia, "vices of civilization," all forms of neurasthenia, as "an active eliminator of uric acid in rheumatism," in hepatic cirrhosis, dyspepsia, asthma, obesity, cystitis ( !) lumbago, exophthalmic goiter, etc. He should also learn the contra-indications to the use of squill, deducible from the fact that it causes vasoconstriction and raises the blood-pressure (prohibiting its use in Bright's disease and arteriosclerosis), and that it produces marked gastric irritation, consequently nausea and depression, that it is a very toxic agent, and that the dangers of cumulative action must be borne in mind. In respect to these the advertisements of the Anasarcin people are little short of criminal, for these state: "Safe in administration." "Non-toxic as ordinarily administered." "Will nauseate some persons," but "the reaction from the tem- porary depression is prompt." "In Bright's disease, both the inter- stitial and parenchymatous forms of nephritis, acute or chronic, no remedy ... to equal it in efficacy." "Without increasing the debility of the patient or interfering with nutrition by producing loss of appetite... "This treatment is to be continued without cessation until all symptoms of dropsy have disappeared." Physicians who are inclined to disregard this warning, and who follow the advice of the Anasarcin people, should remem- ber that their patients-or their friends-will put the blame for the results, which are bound to follow sooner or later, on the prescribers, and not on the deceptive advertisements of the Anasarcin Chemical Company. There is another little matter which throws an illuminating side-light on the Anasarcin Company. They take every occa- sion to say that Anasarcin is "not offered to the laity," "never sold to the laity," etc.; but witness the following, which was found in the Retail Druggist of May, 1906, p. 179. The italics are ours. CURE FOR DROPSY. "As every druggist knows, dropsy has been one of the incurable diseases when caused either from heart, liver or kidney trouble. A pharmacist in Winchester, Tenn., has worked out a remedy called Anasarcin, which he is exploiting to the physicians, and his remedy is showing itself as possessing great merit. Several hopeless cases have been treated as a last resort by Anasarcin and in a very short time the patient has shown marked improvement and has effected permanent cures. 16 PROPAGANDA FOR REFORM "The result of the cases as handled by the physician with the aid of Anasarcin has been so easily and quickly cured that physicians of Tennessee and the southern states are high in their praises of the remedy. The company which now manufactures and sells it is known as the Anasarcin Chemical Co., of Winchester, Tenn. Any druggist who knows of a case of dropsy xoould be conferring a favor on the patient and mankind in general by telling the party or his physician of the southern pharmacist, and we have no doubt but what a prompt relief and permanent cure would be affected." [Probably means effected.-Ed.] Anedemin If we are disposed to doubt the vaunted scientific ability'of the Anasarcin Company, we are forced to admire their busi- ness methods, at least, if there is any truth in the saying that imitation is the seal of success. Anasarcin has had this rather undesirable compliment paid to it, for its native town of Win- chester has given birth to another remedy, Anedemin, which looks like a fair-haired twin brother. The Anedemin Com- pany has adopted Anasarcin almost bodily. The name- ''opposed to edema"-is about as close as the copyright laws permit. The pharmacologic and therapeutic claims agree almost literally with those of Anasarcin and contain the same exaggerations and dangerous misstatements. There is the same emphasis on free purgation with Epsom salts. The dose is the same. Both are marketed at $2.00 for a box of 100- only the Andemin people have adopted the prize package device of throwing in 20 or 30 tablets extra, for good measure, and give a discount of 75 cents or so. In short, the Anedemin Company has appropriated all of Anasarcin which they considered of any value. It is, there- fore, rather suggestive that they drew the line at the formula. Anasarcin is said to contain squill, sambucus and oxydendron; Anedemin discards the oxydendron and reinforces the squill with strophanthus and apocynum. Notwithstanding this mate- rial change in composition, the actions are described as iden- tical; this is again rather suggestive. The Anedemin Company, like the Anasarcin Company, scorns crude drugs and claims to use only the isolated principles. It was saved the trouble of discovering active principles for strophanthus and apocynum, for these are known; but it man- aged to find some scope for its inventive genius, "both drugs being so chemically treated and disposed as to absolutely elimi- nate all objectionable and disagreeable properties and effects" so as to convert a vasoconstrictor action into a dilator action : so as to render them non-toxic and non-cumulative; so as to COUNCIL REPORTS 17 deprive apocynum of its characteristic nauseant effect. Who can say that the days of miracles are past? Even this is not the limit of Anedemin alchemy; if we are to believe their claims, they have succeeded in forcing strophanthin, apocynum, scillain, etc., to combine with each other: "It is a definite chemical compound of the active principles" of these drugs! This makes the achievements of Emil Fischer in synthesizing sugars and proteids appear as mere child's play. Since the formulas were completed, however, clinical reports have been numerous enough-almost too numerous, if we are to believe them. Anedemin has been on the market for less than three years; the circulars emphasize that testimonials Laboratory and Warehouse of the Anasarcin Chemical Company, Winchester, Tenn. and endorsements are not solicited. Nevertheless, we are told that it is "endorsed by over fifty thousand clinicians through- out the United States." Since the total number of physicians in the United States and Canada is only about 128,000, this means that nearly every second physician has endorsed Ane- demin. The Anasarcin Company solicits endorsements and they seem to do the larger business. Hence the majority of physicians of the United States must have written an endorse- ment of either Anedemin or Anasarcin, or both. Or is this statement another "invention"? It is a little peculiar that nearly all the endorsements come from small towns in sparsely settled districts; practically none from the centers of popula- 18 PROPAGANDA FOR, REFORM tion. Does this mean that dropsy is more common in the rural communities than in the cities? THE INVENTORS OF ANASARCIN AND ANEDEMIN Even the newspapers, when they tax our credulity with pre- tended scientific "discoveries," feel the moral obligation of justifying themselves by telling us something of the person- ality and experience of the discoverers. We may ask, there- fore, who are these expert pharmaceutic and synthetic chem- ists, these manufacturers of active principles, these skilled clinicians of wide experience, who have "intelligently built up the formula by wide application"? What are we told of these men who ask us to believe, on their mere assurance, in miracles and feats of magic; who tell us that they have converted neu- tral principles into alkaloids, that they have effected definite chemical compounds between these neutral principles, that they have discovered principles that do not exist, that they have changed the actions of these principles to suit their wishes, that, in short, they have reversed the laws of Nature? These companies are located in Winchester, Tenn., a town of about 1,500 inhabitants, situated in an agricultural country. The town boasts of neither scientific schools, colleges, universi- ties nor laboratories. The Anasarcin Company was organized in 1902, the incorporators and directors being Dr. John W. Grisard and his sons, Dr. John P. Grisard, B. A. Grisard, and A. F. Grisard, and Will E. Walker, all of Winchester. Dr. John W. Grisard seems to be the originator and promoter of Anasarcin. W. E. Walker is an insurance solicitor of Win- chester and is not actively identified with the business. We are informed that he owns but a single share of stock having a face value of $100, and that he was added to the company in order to comply with the laws of Tennessee, which require five directors for any corporation. Dr. John W. Grisard, the father, has practically retired, but still has a general supervising interest in the business. There is no regularly licensed phar- macist or chemist connected with the company. The office is in the rear of a jewelry store in the business part of Winchester and on the second floor above. According to our reporter, an office force of about ten stenographers and clerks handles the correspondence and labels and sends out the preparation which is made in a crude frame building located on a side street and without laboratory equipment, According to our reporter, the work is done by the Grisards and a colored man. The Anedemin Chemical Company was organized in 1905 with a capital of $20,000, the incorporators and directors being COUNCIL REPORTS 19 Dr. T. B. Anderton, Floyd Estill, J. J. Lynch, J. M. Littleton and I. G. Phillips, all residents of Winchester, and all lawyers with the exception of Dr. T. B. Anderton. A Mr. Gordon, a clerical employee of the company, is reported to have active charge of the business, to prepare the medicine and conduct the correspondence. The office headquarters, laboratory and complete outfit of the Anedemin Company comprises two rooms over the law office of Estill & Littleton. No one connected with the company is a regularly licensed pharmacist or grad- uate chemist. Of the six physicians located in Winchester, three of them (50 per cent.) are engaged in the dropsical cure business. Poor Winchester! Aside from their connection with these two nos- trums, these physicians may be estimable and worthy citizens, but where, pray, did they.find the extensive clinical facilities and pharmaceutical knowledge necessary for their wonderful and epoch-making discovery? Were they aided in their scien- tific work by the four lawyers connected with the Anedemin Company or by the insurance solicitor who is a director of the Anasarcin Company? Did tbe 1,500 inhabitants of the town furnish the vast clinical material necessary for discovering and working out the formulas of these two preparations? If so, we fear that dropsical affections are much more prevalent in Winchester than in any other known spot on the globe. This matter should be investigated. Without doubt the vital sta- tistics of Franklin County would be most interesting and we commend them to the special attention of the medical profes- sion in Tennessee.-(From The Journal A. M. A., May 4 and 11, 1901, pp. 1535 and 161,1.) CACTUS GRANDIFLORUS Report of the Council on Pharmacy and Chemistry The Council voted that cactus grandiflorus should not be accepted for New and Nonofficial Remedies, and that a state- ment be prepared for The Journal giving the reasons for this action. Accordingly the following report has been adopted by the Council and its publication authorized. W. A. Puckner, Secretary. Cactus Grandiflorus The therapeutic value of this plant has been variously esti- mated by different observers. Experimental evidence as to its action is scanty and no complete chemical examination has ever been made. 20 PROPAGANDA FOR REFORM Reputable men have testified that some of the plants of the cactus family contain very active principles, but so far experi- ments seem to prove that cactus grandiflorus has neither the action of digitalis nor that of strychnin. The principal con- tributions, clinical and experimental, for and against the drug, are set out below. EXPERIMENTAL EVIDENCE 0. H. Myers1 worked with a product which he calls cactina and which he regards as the active principle of the drug. (As no such substance as cactina is described in any materia medica, it is impossible to state what Myers really used.) He found that it had a strychnin-like action and raised the blood- pressure. Hatcher comes to the conclusion: "Either Myers' work was a pure fabrication or he was dealing not with cactin but with a substance similar to the pellotin of Heffter, the action of which resembles that of strychnin to a certain extent." E. Boinet and J. Boy-Teissier2 experimented with an aqueous extract, an alcoholic extract, and with an alkaloid which they call "cactine." They concluded from three sets of experiments on frogs that extract of cactus produces, in ten minutes, a temporary increase in the heart's action which frequently repeated doses are required to maintain; and that large doses slow the heart and produce arhythmia. L. E. Sayre3 experimented with a preparation of cactus, made ffom the stem of the plant, by injecting it into, the dorsal lymph space of the frog. There was seemingly an increase in the amplitude of the heart's action and an indica- tion of a strengthened beat or increased force. R. A. Hatcher4 states that it is possible that cactus grandi- florus, under certain conditions, may contain a principle with a strychnin-like action. But Hatcher made ten experiments on frogs, four on cats, six on dogs, two on rabbits, and one on a guinea-pig, with Cactina pillets of the Sultan Drug Company and the cactin of the Abbott Alkaloidal Company. From 1 to 15 pillets in frogs and up to 25 in dogs were used at each dose. In no single instance was there any evidence of a digi- talis-like or strychnin-like action, or, in fact, of any decided action of any kind whatever. 1. New York Med. Jour., 1891, liii, 681-683. 2. Bull. Gen. de Therap., 1891, cxxi, 343-349. 3. Am. Pharm. Assn., 1906, liv, 405. 4. The Journal A. M. A., Sept. 21, 1907, pp. 1021-1024. COUNCIL REPORTS 21 Gordon Sharp3 was unable to obtain either alkaloid or glu- cosid from the plant, but found a series of resins that caused contraction of the blood-vessels of a frog. This was not a digitalis-like contraction, but depended, he believed, on simple acidity. On the heart of the frog the resins have little or no effect, comparisons being made with digitalis in the same animals. There is no proof that cactus grandiflorus itself shortens diastole, or in fact, that it has any special action on the heart muscle at all. Sharp experimented on himself with large doses of an extract made with alcohol 1 to 5, but got no noticeable results. He thinks that the plant may have some slight diuretic action. Sayre submitted the preparation which he used in his experiments for more careful testing to E. M. Houghton, who reported that it had practically no action on the heart. In commenting on Houghton's results, Reid Hunt said that they were confirmed by his own experiments. He did not deny, however, that the drug might have some therapeutic effect and that, in very large doses, it did affect the kidneys. S. A. Mathews8 found one preparation of cactus (cactin- Abbott) absolutely inert so far as any effect on the heart is concerned. He found that cactina (Sultan Drug Co.) in very large doses depressed both the circulation and respiration. In this regard it differs from strychnin, and it has no resemblance to the action of digitalis, strophanthus or any of the heart stimulants. A dose of from 10 to 12 pillets administered intravenously to a 10 to 12 kg. dog exerted little or no influ- ence on the heart or circulation; the larger dose may cause a slight fall in blood-pressure. When 70 or more pillets were administered within two and a half hours the animal generally died. The work of Boinet and Boy-Teissier also has been critcized by Hatcher on the ground that their most positive results were obtained with an alkaloid which no one at this day is able to prepare. The results quoted in this report, however, were obtained by the use of extracts of cactus so that it does not seem that they should be entirely rejected, whatever their value may be. CLINICAL EVIDENCE Clinical observations have been more abundant than exact, and a favorable action of the drug in some organic diseases of the heart has been reported; other observers would limit 5. Practitioner, London, 1894, iii, 444-44G. G. The Journal A. M. A., March 21, 1908, 1, 956-958. 22 PROPAGANDA FOR REFORM its use to functional arhythmia, insisting that it is not a substitute for digitalis or aconite, but that it occupies a place distinct from either of those remedies. P. W. Williams7 recommends cactus for functional heart disease, but, as a rule, found it useless in organic disease. He thinks it one of a class of remedies which act on the acceler- ator nerves and sympathetic ganglia, shortening the diastole and stimulating the spinal vasomotor nerve centers. Williams apparently relied on Myers for his knowledge of the pharma- cologic action, and his paper is a fair example of the clinical studies of cactus. Ellingwood8 claims that cactus is a cardiac tonic, acting on the accelerator nerves and heart ganglia, increasing muscular force and arterial tension. He recommends it in both organic and functional diseases. Boinet and Boy-Teissier found that therapeutic doses of 40 drops of tincture of cactus were without effect on the normal heart. In patients with noisy asystole (asy static bruyante) the same dose produced no appreciable effect. In the period of latent non-compensation of true cardiac patients, from 80 to 100 drops a day increased the force of the failing heart. In patients with secondary heart disease with arrhythmia of ner- vous origin, daily doses of 80, 100 and 120 drops of the tinc- ture were well tolerated for weeks; they seemed to increase the fulness of the pulse and regulated its rhythm. In spite of such large doses, these observers never noticed any symp- toms that could be attributed to a cumulative action. It must be remembered that the precise preparation of cactus which they used is not known. Aulde9 recommends it as a cardiac tonic free from cumula- tive effects. Gordon Sharp says: "The therapeutics of the subject, I think, are clear enough. Cactus grandiflorus cannot be included in our list of cardiac drugs. It is not even a simple stomachic tonic and at most all one can say is that it has small diuretic action." Hatcher says: "Clinical testimony is so conflicting that between the extreme views of Gordon Sharp and those of Ellingwood there is room for an honest difference of opinion concerning cactus grandiflorus." Matthews himself took 100 granules of cactin (1/67 gr.-1 mg. each), 25 every four hours, without experiencing the least effect. 7. Practitioner, London. 1891, xlvii, 266-273. 8. Med. Rec., New York, 1905, Ixvil, 857. 9, Practitioner, London, xlvii, 223 ; Therap. Gaz., 1890. COUNCIL REPORTS 23 CONCLUSIONS Reliable conclusions regarding the therapeutic use of cactus grandiflorus are rendered difficult on account of several factors. 1. It is uncertain what part of the plant contains the active principle if one exists; and its nature is unknown. The National Standard Dispensatory states that its "activity must be confined to the flower in some special stage of its develop- ment or to a certain part of it or to some parts gathered with it." This uncertainty may explain the negative results obtained by some observers but it makes the drug one that cannot be generally relied on and gives an excellent oppor- tunity for the exploitation of proprietary preparations, 2. Some of the experimental work and much of the clinical evidence has been obtained and published under proprietary auspices. For this reason many of the therapeutic claims made for the drug must be viewed as merely the reflection of the exaggerated statements made by the advertisers of pro- prietary preparations. 3. The value of clinical evidence when unsupported by ani- mal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute, to the drug given the effect really due to general remedial measures, psychic suggestion and so forth. While it must be admitted that valuable remedies may exist whose therapeutic properties cannot be revealed by animal experimentation, yet in the absence of such experimental evidence conclusions should be drawn with extreme caution. Bearing these conditions in mind, the following statements seem to be justified: (a) The botanical, chemical and phar- maceutical properties of cactus are not sufficiently determined to make any available preparation a reliable remedy. (&) There is some evidence that cactus may be capable of affect- ing the animal heart and nervous system, but its action is not that ordinarily attributed to it. It does not increase the force of the heart-beat, (c) While there is some clinical testi- mony as to its usefulness in functional diseases of the heart, the indications for its administration are at present too uncer- tain to afford a safe basis for recommending it. 4. While the drug may be deserving of further experimental and clinical investigation, this should be carried on in reliable pharmacologic laboratories and in clinics provided with facil- ities for exact observation.-(From The Journal A, M. A., March 12, 1910.) 24 PROPAGANDA FOR REFORM CAMPHO-PHENIQUE Report of the Council on Pharmacy and Chemistry and Some Comments Thereon The following report was submitted to the Council on Phar- macy and Chemistry by the subcommittee to which Campho- Phenique had been assigned: To the 'Council on Pharmacy and Chemistry:-Campho- Phenique, sold by the Campho-Phenique Co., St. Louis, Mo., is claimed to be composed of phenol 49 per cent., and camphor 51 pei' cent. Examination of specimens, purchased in the open market, made under our direction, demonstrate that the statements made in regard to the composition are not true. Instead of containing 49 per cent, of phenol (carbolic acid), the analysis showed that it contains not more than 20 per cent. Instead of containing 51 per cent, of camphor, the analysis demon- strates that the amount of camphor is not more than 38 per cent. Besides phenol and camphor, a third substance was found which proved to be liquid petrolatum and to be present to the extent of 38 per cent, or more. Since the statements made in regard to the composition of Campho-Phenique are deliberate misrepresentations of the facts, it is recommended that the article be not approved. Besides Campho-Phenique, the above-mentioned firm also sells a preparation labeled Campho-Phenique Powder. While no statement in regard to the composition of this product is made on the label or in the literature, such expressions as "Campho-Phenique in a powdered form" and "Powdered Cam- pho-Phenique" lead to the inference that it has essentially the same composition as that stated for the liquid preparation. An examination of a specimen of Campho-Phenique Powder purchased in the open market showed that 92 per cent, of it was a talcum-like inorganic substance. The remaining 8 per cent, consisted chiefly of camphor with a small amount of phenol. In view of the fact that Campho-Phenique Powder contains very little phenol, but instead consists chiefly of an inorganic talcum-like substance, its name is misleading and deceptive. It having been shown that Campho-Phenique Powder corre- sponds to a camphorated talcum powder, the claims that it "has no equal as a dry dressing," that it is "absolutely supe- rior to iodoform," and that it has "all the excellent properties of aristol and iodoform," are unwarranted. It is recommended that the article be not approved, and that this report be pub- lished. The recommendations of the subcommittee were adopted by the Council, and in accordance therewith the above report is published. W. A. Puckneb, Secretary. COUNCIL REPORTS 25 Campho-Phenique The above report on a much advertised "ethical" proprie- tary medicine is worthy of the thoughtful consideration of the members of the medical profession, as it illustrates admirably some of the conditions connected with this proprietary med- icine business. THE FORMULA A FAKE First, it illustrates the fact that the published formulas of the "ethical" proprietaries are not always reliable. The Campho-Phenique Company has been very willing to give out a formula, purporting their product to be 51 per cent, cam- phor and 49 per cent, phenol (carbolic acid). Now, these two drugs will make a liquid mixture, and any druggist can make it, and the mixture will have about the same consistency and appearance as Campho-Phenique. But its effect differs decid- edly from that of Campho-Phenique. Some months ago a very intelligent physician, in discussing the proprietary medicine business, said that in some cases physicians could not get druggists to make preparations which were as satisfactory as those which could be bought ready-made. He cited Campho- Phenique as an illustration. He said that he had used this preparation for burns, etc., but as he did not like to use prepa- rations put up by companies about which he knew nothing, he asked his druggist to make the mixture in accordance with the published formula. The druggist's preparation was not satisfactory; it had a decidedly different effect from Campho- Phenique, and so he tried another druggist. This druggist also followed the published formula, but his results, too, dif- fered materially from the proprietary article. The various analyses that have been made show why the preparations put up by the druggists did not resemble that made by the company; since, according to the analyses, Campho-Phenique consists of 40 per cent, liquid petrolatum, which is an inert but soothing diluent, while instead of 49 per cent, of carbolic acid, as claimed, it really contains less than 20 per cent. This is an entirely different proposition. Now, if the physician referred to above will have his druggist make a mixture of 20 per cent, of carbolic acid, 40 per cent, of camphor and 40 per cent, of liquid petrolatum, and will then compare this resulting compound with Campho-Phenique, he will find that there is not much difference. Furthermore, he will realize that there is nothing either new or wonderful about the preparation. Camphorated oil and carbolized oil are both in common use. Campho-Phenique is apparently simply a mixture of the two. 26 PROPAGANDA FOJi REFORM. THE POWDER STILL WORSE So much for the liquid. The powder seems to be something entirely different, for, according to the chemist's report, over 90 per cent, of it is inert, absorbent, talcum-like material. There is enough camphor and carbolic acid to give the powder an odor and thus mislead physicians, especially those who are in the habit of taking for granted that whatever statements nostrum manufacturers make are true. Perhaps it is a fairly good dressing for wounds-at least it will do no harm--but its name is misleading and deceptive. For all practical pur- poses it is essentially a camphorated talcum powder. COMPANY A "PATENT-MEDICINE" CONCERN The second interesting phase of this "ethical" proprietary is that it illustrates another point, i. e., that many of these articles are supplied to our profession by those who are not legitimate manufacturing pharmacists. The Campho-Phenique Company of St. Louis, according to all reports, is owned and controlled by a gentleman named Ballard. This "company" supplies the medical profession with the preparations under consideration and also with chloro-phenique and scrofonol. We are informed that this same Mr. Ballard is the principal owner, if not the sole owner, of quite a number of "patent- medicine" companies, such as Ballard-Snow Liniment Co., Brown's Iron Bitters Co., Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain's Laboratory, and several others. We learn from the wholesale drug trade lists that these various "companies" make and sell, beside the campho-phenique prep- arations, Ballard-Snow Liniment, Ballard's Herbine, Brown's Iron Bitters, Dr. Herrick's Pills, Richardson's Life-Preserving Bitters, Smith's Bile Beans, Swain's All Healing Ointment, and several other "patent medicines." It is hardly necessary to make any further comments. The whole business is nauseating to those who know the actual conditions of this nostrum business and how our profession is being deluded. The Campho-Phenique matter is not an excep- tion; it is simply another illustration of these conditions. The majority of "ethical" proprietaries are foisted on our profession, either without any formula accompanying them, or with a "formula" that is a fake. The majority of the "ethical" proprietaries are manufactured and supplied to physicians, with instructions regarding their use, by men who bear the same relation to legitimate pharmacy that the veriest quack that ever swindled a credulous public bears to scientific med- icine.-(From The Journal A. M. A., April 20, 1907, 1365.) COUNCIL REPORTS 27 COMPRESSED OXYGEN Report of the Council on Pharmacy and Chemistry The referee of the Council appointed to report on the composition of compressed oxygen as found on the market and to make recommendations as to its inclusion with New and Nonofficial Remedies submitted the following report: The Section on Stomatology at the 1909 session of the American Medical Association having recommended the inclu- sion of compressed oxygen with the U. S. Pharmacopeia, the Council voted to describe this product with New and Non- official Remedies until such Pharmacopeial recognition had been secured. This action having been decided on, it became necessary to provide standards of purity for this substance. Correspondence both with firms who make the product as well as with those who use it gave the referee of the Council little information as to what degree of purity should be required for this substance, and it therefore became necessary to examine the product as it was found on the market. Professor Warren R. Smith of Lewis Institute, Chicago, kindly offered to cooperate with the Council and to make an examination of this product. The referee herewith transmits the very thorough report regarding the composition of com- mercial compressed oxygen which has been made by Professor Smith in collaboration with Edwin D. Leman. The referee recommends that the Council express its appreciation for the work and that it request publication of the report in The Journal. The referee further recommends that the descrip- tion of compressed oxygen submitted herewith be adopted for inclusion with New and Nonofficial Remedies. This report was adopted by the Council and in accordance therewith the examination of Smith and Leman is published below and the description of compressed oxygen appears with New and Nonofficial Remedies on another page of this issue of The Journal. W. A. Puckner, Secretary. The Purity of Compressed Oxygen PROF. WARREN R. SMITH AND EDWIN D. LEMAN We have recently examined three specimens of commercial oxygen, purchased in the open market, with the results shown in the accompanying table. The gas from the Chicago Oxygen Co. was claimed to be under a pressure of 16 atmospheres. The amount of nitrogen found in this sample is just about that which would be present if pure oxygen were forced into a container filled with PROPAGANDA FOR REFORM 28 Maker 1 Ohio S. S. White Chicago Chemical Dental Oxygen Gas Co., and Mfg. Co., Mfg. Co., Chicago Cleveland Philadelphia Per cent, oxygen « Per cent, nitrogen'- j Potassium iodid test.. .. Per cent, carbon dioxid. Carbon monoxid methane, etc | 94.78 94.80* 97.84 97.85* 96.84 96.76* i 94.78 94.80f 97.84 97.86f 96.84 96.93f 5.22 5.20* 2.15 2.16* 3.09 3.17* 5.22 5.20t 2.14 2.16f 3.09 3.00f Negative. Negative. Negative. Negative. Negative. 0.06 0.07* Negative. Negative. Negative. 1. That is, not absorbed by potassium pyrogallate. * Smith. t Leman. air under one atmosphere pressure until a pressure of 16 atmospheres w7as reached. The other samples were stated to be under a pressure of 1,600 lbs., so that the amounts of nitrogen found cannot be accounted for by a similar hypoth- esis. The potassium iodid test mentioned in the table consisted in passing from 2 to 4 liters of the gas through a solution con- taining starch and potassium iodid. A negative result in this test shows that the gas is free from chlorin, ozone, oxids of nitrogen, etc. The negative results for carbon dioxid mean that not more than a slight opalescence was obtained by pass- ing 2 to 4 liters of the gas through a solution of barium hydroxid. The carbon monoxid test was made by passing the gas through alkali to remove all carbon dioxid, then over heated platinum, and finally through barium hydroxid solu- tion. A negative result here shows freedom from carbon monoxid, methane and other hydrocarbons.- (From The Jour- nal A. M. A., March 18, 1911.) CURARE Report to the Council on Pharmacy and Chemistry Physiologically, curare is an exceedingly active drug; its therapeutic value, however, in the opinion of the Council, is largely hypothetical. Added to this is the impossibility of obtaining pure material of definite action and the confusion that exists in regard to the names of the alkaloid obtained from different kinds of curare. For these reasons, the Council has voted that curare and curarin be not described in New7 and Nonofficial Remedies, but in view7 of the fact that these COUNCIL REPORTS 29 drugs are often referred to in medical literature it is thought advisable to publish the following general article. W. A. Puckner, Secretary. Curare Under the name curare several varieties of native extracts used as arrow poisons are known. These are commonly indi- cated by the kind of container in which they come into com- merce, and are called calabash curare, tube curare (coming in bamboo), and pot or jar curare (German Topf). The calabash curare is obtained principally from Strychnos toxi- ■fera, and contains the alkaloid curarin : the tube curare, or tubo- curare, is from an undetermined source, it yields the alkaloids, tubocurarin and curin ; the third variety of curare coming in jars is obtainable chiefly from Strychnias Castelncei and Cocculus toxiferus and contains the alkaloids protocurarin and protocurin. Curare is variously called urari, woorari and woorali. The method of preparation is not known. The various curares are found in brown masses of an intensely bitter taste, not wholly soluble in water but more soluble in dilute acid. Action and Uses.-Curare paralyzes the endings of motor nerves in striped muscles in the • following order: (a) short muscles of the toes, ears and eyes; (b) limbs, head, and neck; (c) respiration; (d) the heart, which is not affected except with very large doses. The paralysis does not affect the sensory nerves. In warm-blooded animals death occurs from paralysis of the respiration, convulsive movements some- times occur and glycosuria is occasionally produced. In man little or no effect is produced when it is administered by the mouth. Small hypodermic doses increase the force and the fre- quency of the pulse, raise the temperature slightly and cause perspiration and an increase in quantity of the urine. From larger quantities of the poison violent febrile phenomena occur, commencing with the characteristic symptoms of a severe chill. Paralysis of the lower extremities comes on and may last from a few minutes to an hour. The fever may continue^ for 5 or 6 days if the dose is larger. Curare has been used but with little success in the treatment of tetanus and other con- ditions in which convulsions are prominent, and for this pur- pose it may be injected subcutaneously. Curare should be used only after the specimen has been tested and the dose should be calculated as follows: The fatal dose per kilogram of dog is determined and one-tenth of this amount is administered for each kilogram of weight of the PROPAGANDA FOR REFORM 30 patient. This dose may be cautiously increased until there is some interference with respiration if care be taken not to induce total paralysis of respiration and if preparation has been made to carry on efficient respiration if it should become necessary. Dosage.-The exact dose cannot be stated, as will be under- stood from what has been said, but the crude extract is some- what variable in activity, and it would seem to be much bet- ter to use only the pure alkaloid curarin for therapeutic pur- poses. Physostigmin is the physiologic antidote-but arti- ficial respiration must be the main dependence. Curarin Curarin (C1oH24N'20), is the alkaloid prepared from cala- bash curare. Curarin is a deliquescent powder soluble in water and alcohol (Merck). Oxidized by potassium permanganate it yields amines and oxalic acid. In general it has the properties of a quaternary base. It has a bitter taste. Action and Uses.-The pharmacologic action of curarin has been described under curare, but mention should be made of certain differences between the several alkaloids found in the different varieties of curare. Curarin first paralyzes the motor nerve endings without affecting the heart and blood- pressure to an important degree. Tubocurarin has a very much weaker action on the motor nerve endings than has curarin. It first stimulates the reflex excitability of the cord which it later depresses. It' also has a much greater effect on the heart, increasing the rate. The increased reflex irritability may persist with small doses. Curin does not participate in the action of curarin on the motor nerve endings but acts directly on the heart, first increasing the systole, then depressing it; the heart finally stops in diastole after fatal doses. Protocurarin acts qualitatively like curarin, but it is more active. Curarin is used for the same purposes as curare, but it l^as the advantage of being more constant in its action. Dosage.-Curarin is used therapeutically only for its action on the motor nerve endings and the dose must be very care- fully regulated by the effects. From one to twelve milli- grammes are injected for a man. The dose should be cau- tiously pushed until the extremities are motionless. The means for carrying on artificial respiration must be at hand, and if the respiration is seriously impaired artificial respira- tion must be carried on. The drug is very rapidly excreted COUNCIL REPORTS 31 by the kidneys and natural respiration is soon restored if the dose has not been excessive. The heart must also be carefully watched. Owing to the differences in physiologic action between the curarins of different origin it is unfortunate that a manu- facturer should give tubocurarin as a synonym for curarin. CONCLUSIONS 1. Curare is a powerful and dangerous respiratory and cardiac depressant and paralyzant of motor nerve endings in striped muscle. 2. The value of curare either in tetanus or in any other disease is questionable. 3. No dose can be stated. The antidote, physostigmin, must be at hand and one must be ready to perform artificial respira- tion after each administration. 4. Each of the several alkaloids from the three varieties of curare has a different strength and a somewhat different action. 5. These alkaloids are not at present sufficiently differen- tiated in commerce to enable a physician to know which one he is using.- (From The Journal A. M. A., Jan. 15, 1910.} DIASTASE FERMENTS Report of an Examination of the Diastase Ferments by the Council on Pharmacy and Chemistry A subcommittee makes the following report to the Council with the recommendation that it be published: Among medicinal agents which may be classed as legitimate pharmaceutical preparations few are more widely advertised than are the starch-digesting ferments, the diastases. Along with a number of very good preparations there are several for which grossly exaggerated claims are made, and which are advertised to the medical profession in such a manner as to lead to distrust. Those which have merit have not always been marketed by methods which are wholly free from criti- cism. In several cases the claims made are more than can be substantiated by actual tests. There has always been some obscurity in the method of reporting the digesting value of these diastases, and just what is meant by starch conversion or sugar formation is not always clear. In other words, the claims of the manufacturers are frequently stated in terms which are too general. To be of value statements regarding the digesting power of the diastases should be based on standard and uniform meth- ods of testing. But manufacturers have followed different 32 PROPAGANDA FOR REFORM methods of examination, which naturally makes a fair com- parison of products difficult, and in some cases impossible, for any one not conversant with the methods of analysis. Recog- nizing the importance of uniformity in such work the subcom- mittee has had a large number of comparative tests carried out on the more important products of this class, employ- ing several methods of analysis. In practice the diastatic action may be measured in terms of malt sugar formed from an excess of starch in a given time, or by the conversion of the starch to a point where the test with iodin shows the disappearance of the blue color, or the disappearance of all color. Results by these three methods are not directly com- parable, although there must be some relation between them. Our first experiments were directed toward the clearing up of this point. These experiments were carried out largely by Mr. W. A. Johnson and the most important of them are given in detail in a paper which appears in the May number of the Journal of the American Chemical Society. From his numer- ous tests Mr. Johnson concluded that the best practical com- parison may be made by carrying each digestion to the color- less end point, and in his paper certain suggestions are made as to the best methods of conducting the tests. These will be referred to below. The following table contains the results obtained with a num- ber of commercial products, when examined, in this way, the digestions being continued through a period of ten minutes, at a thermostat temperature of 40 C. in all cases. All the products here examined came from the manufacturers, and the results were confirmed by tests on similar products bought in wholesale drug houses. The results are expressed in four ways for comparison as follows: A.-Parts of 100 % starch digested to colorless endpoint in ten minutes. B.-Parts of 92 % starch digested to colorless endpoint in ten minutes. C.-Parts of 85 % starch digested to colorless endpoint in ten minutes. D.-Parts of 85 % starch digested to loss of blue iodin reaction in ten minutes. * Holadin A. 102.1 B. 111.0 C. 120.0 D. 171.0 Taka Diastase 16.0 17.4 18.82 26.0 Taka Diastase Liquid. 0.38 0.41 0.45 0.61 Panase 113.0 123.0 133.0 203.0 Panase Essence 3.6 3.91 4.23 6.1 Vera Diastase Essence 4.2 4.55 5.0 6.7 Diazyme Essence.... 6.12 6.66 7.14 10.3 Diazyme Glycerolc. . . 6.12 6.66 7.14 10.3 Maltine, Plain 2.30 2.50 2.71 Maltzyme 2.87 3.12 3.37 Trommer's Extract of Malt, plain 0.65 0.71 0.77 Trommer's Extract with Cod Liver Oil 0.38 0.41 0.44 COUNCIL REPORTS 33 The blank spaces in the fourth column of figures indicate that no tests were satisfactorily completed here to show the conversion to loss of blue color. In fact, with highly colored mixtures this test is not as easily made as the other. A comparison of the results given in the table with the statements which appear in the manufacturers' circulars, etc., show that the digestive values are all lower than claimed, if we base our comparison on the colorless endpoint reaction and anhydrous starch conversion. If, however, we carry the diges- tion merely to the loss of blue color, which seems to be the case in some of the tests frequently cited, and employ starch with an average water content of about 15 per cent., a very different status must be reported. In this manner of report- ing results five of the preparations show even more than the claimed values, but the method should not be tolerated for obvious reasons. The results actually found should always be calculated to anhydrous starch for reporting. The discrepancies between the values claimed for Holadin, Diazyme Essence and Diazyme Glycerole and those actually found in our tests are not very great. While one part of Holadin by the firm's method is stated to digest 135 parts of starch to the practically colorless end- point, column C shows that by the method employed in these experiments only 120 parts of 85 per cent, starch were digested to the colorless endpoint. Similarly, while for Diazyme Es- sence and Diazyme Glycerole it is stated that 1 c.c. will digest 8 gm. "dry" starch to the colorless endpoint, the results given in the table above show that one part digested 6.12 parts of 100 per cent, starch to the colorless endpoint. This is equiva- lent to 7.14 parts 85 per cent, starch, the kind referred to by the manufacturer. The claims made for Panase are somewhat misleading and conflicting. In a recent circular issued by the manu- facturers a statement is made to the effect that one part of Panase "is capable of digesting at least 200 times its weight of starch in 10 minutes," while in another part of the same circular the complete conversion of 200 parts of starch into sugars is claimed as the work of 1 part of Panase. This claim is certainly wrong, as there is a wide difference between the two kinds of reactions. The figures in the table are sufficiently clear on this point, and suggest a proper modi- fication of the claim to agree with the facts. The widest discrepancy between the values as claimed by the manufacturer and those found by actual tests seems to be shown in the case of Taka Diastase. The liquid preparation has been tested a number of times in different samples and has always been found weak. Some sampies, in fact, were quite inert. This ferment appears to lose strength very rap- idly in solution, as the manufacturers now concede. The stabil- ity of the solid product is also far from satisfactory, and ap- 34 PROPAGANDA FOR REFORM pears to be less than that of the ferment as marketed some years ago. The two samples examined recently were weak. From a number of experiments made it appears that the stability of the diastase preparations from the pancreas is greater. In two tests of the Holadin, made some months apart, no appreciable change was noticed. The same thing is true of Panase and the earlier product of the same firm, Vera Diastase. But in the liquid form these preparations, like the Taka Diastase, seem to undergo some alteration in con- verting power, as the figures above, and others, suggest. Of the samples reported here the Vera Diastase essence was ob- tained fresh and examined at once, while the Panase Essence was on hand some time before the tests were made. Accord- ing t6 the statement on the label the latter should be the stronger, but the reverse is the case. The Panase Essence seems to convert less than is claimed for it, -while the Vera Diastase Essence converts more, if we consider 85 per cent, starch and digestion to loss of blue color merely, as satisfac- tory conditions of the test. It is possible that the somewhat greater age of the Panase Essence may have some bearing on the result. The two Diazyme preparations appear to be stable, as far as practical requirements are concerned. We have examined the contents of the same bottles of these products at periods three months apart, and found no changes in the starch-con- verting power. The claims for the numerical value of the diastatic activity and also for the stability which are made for these liquid preparations seem to be borne out by the facts as observed. For the other liquid preparations, Maltine, Trommer's Extract, Plain, and Trommer's Extract with Cod Liver Oil, there are no exact claims as to the digestive power. For Maltzyme, it is claimed that 1 gm. has the power to produce from starch, in 30 minutes, at 37.8 degrees C., 6 gm. maltose. They contain large quantities of the products of enzyme diges- tion, and have relatively low residual digestive value. They should be classed among the so-called medicinal foods, rather than as agents of digestion. In the experiments carried out by Mr. Johnson, referred to above, sugar determinations were made also, and these showed a close agreement with the starch .conversion, carried to the colorless end-point. In making the tests for the sugar forma- tion advantage was taken of the results of the other tests, and enough ferment was weighed out in each case to effect the hydrolysis of one gram of anhydrous starch to the colorless end-point in ten minutes. A series of tests was made on each substance with the same weight of ferment and starch paste, and at the end of 10, 30, 60, 120 and 180 minutes a flask containing the mixture was removed from the thermostat, and the amount of sugar formed, calculated as maltose, was deter- COUNCIL REPORTS 35 mined. On removing each flask from the thermostat further action was always checked by immediate boiling. The amount of sugar formed at the end of ten minutes was essentially the same in all the samples tested, which included the first eight of the table above. For the gram of anhydrous starch, made up to a 2 per cent, paste, the maltose formed varied between 611 and 635 milligrams, which agrees very well with the usual findings for diastase digestion, under like conditions. There are many such results in the scientific literature. In the longer periods, however, the amount of sugar formed by the Taka Diastase increased somewhat more rapidly than was the case with the other ferments, and the results of the determination after 180 minutes pointed to the evident con- version of some of the maltose into glucose. The mean value of the maltose formed by the other ferments in this time was about 860 milligrams, with variations from 855 to 872 milli- grams, while for the Taka Diastase it was over one gram. But to secure these close results it must be remembered that very different amounts of the several ferments had to be taken at the start; that is, for the weaker digestants more, and for the stronger less was weighed out. The amounts taken varied inversely as their starch digesting activity, as shown by the first line of tests. These relations may be illustrated by the figures in the fol- lowing table, in which the first column gives the name of the substance, the second the number of milligrams actually re- quired to convert 1 gram of starch to the colorless end-point in 10 minutes, and the third the weight of maltose formed in this time. The ferment substances were suspended in water and the proper volume was measured out to give the calculated weight. The sugar was found by titration with standard Feh- ling solution, and is calculated as pure maltose, proper allow- ance being made for the dilution of the titrated solution. The sugar amounts found under these conditions are essentially the same, but in producing the sugar 8.85 milligrams of Panase go as far as 9.79 milligrams of Holadin, 62.5 milligrams of Taka Diastase, 163.4 milligrams of the Diazyme liquids or 238.1 milligrams of the Vera Diastase Essence. In making comparisons by the table the fact must not be overlooked that the three preparations there last named are in solution, while the others are solids. TABLE OF SUGAR FORMATION IN 10 'MINUTES Column A gives the weight of ferment required in each case. Column B gives the weight of sugar formed in each case A. B. Panase 8.85 622 mg. Holadin 9.79 634 mg. Taka Diastase 62.5 611 mg. Diazyme Essence 163.4 633 mg. Diazyme Glycerole 163.4 635 mg'. Vera Diastase Essence 238.1 630 mg. 36 PROPAGANDA FOR REFORM These results, which have been obtained many times in re- peating the tests, show that the starch conversion to the color- less end-point, which is more easily and quickly carried out than is the sugar' determination, gives a practically useful measure of the ferment activity, and a measure which bears a close relation to that of maltose formation. We, therefore, recommend the process for all the routine examinations of this nature which have to be made in the testing of the dias- tase ferments. As is explained in the article by Mr. Johnson, the process here employed was first suggested by Roberts for the examination of ferments of animal origin, and was later modified by Junck and by Francis, and applied to the fer- ments of vegetable origin. In our laboratory it has been sub- mitted to critical revision with the object of securing greater accuracy through a fuller specification of details of manipula- tion. The most important points of the process are these, which are presented as easily and practically workable: 1. A clean grade of potato starch is thoroughly washed, first by decantation and then on a Buchner funnel. It is care- fully dried at a low temperature, and finally at a higher temperature to a moisture content of about 10 per cent., the exact moisture content to be determined in a separate experi- ment. 2. For the actual tests about 22 grams of the starch is mixed with 100 c.c. of solid distilled water to make a uniform cream and then poured into 800 c.c. of boiling distilled water. The boiling is continued through ten minutes, and then enough water is added to make the actual starch content (anhydrous) exactly 2 per cent, by weight. For each -test quantities of exactly 50 grams of the paste are weighed into a series of 250 c.c. flasks, which are clamped in a large water-bath kept at a temperature of 40 degrees. 3. The iodin test solution is made by dissolving 2 grams of iodin and 4 grams of potassium iodid in 250 c.c. of distilled water; 2 c.c. of this solution is then diluted with pure water to make 1,000 c.c. 4. In making up the diastase solution the operator must be guided by the results of a few preliminary experiments in each case. For liquid malt extracts, for example, 10 c.c. diluted to 100 c.c. will generally be a proper strength, while in the examination of the dry preparations on the market 200 to 500 milligrams, dissolved or suspended in 100 c.c. of dis- tilled water will usually answer. 5. These solutions are used in this way: Small definite volumes of the dilutions are added to the flasks containing the starch paste in the thermostat, and with the least possible loss of time. The mixtures are well shaken. The volumes added may be as follows, but all diluted to that of the largest volume before mixing: 1 c.c., 2 c.c., 3 c.c., 4 c.c., 5 c.c., 6 c.c., In about eight minutes tests are begun by removing volumes COUNCIL REPORTS ' 37 of 5 drops from each digesting mixture by a pipette and add- ing this to 5 c.c. of the dilute iodin solution in a clear white test-tube standing over white paper. It is best to have a row of these tubes mounted to receive the liquids to be tested. If at the end of ten minutes drops from one of the flasks fail to give the iodin reaction we are ready for a second and more accurate test. Weigh out now 100 grams of the paste into each of six flasks, and, assuming that the end-point in the first test was found between 4 and 5 c.c., add accurately to the six flasks these volumes of the diastase solution: 8 c.c., 8.4 c.c., 8.8 c.c., 9.2 c.c., 9.6 c.c. and 10' c.c. These volumes should all stand ready and all diluted to 10 c.c., so that they may be poured into the starch and shaken up without delay. They should also have the normal thermostat temperature of 40°, which precaution should be observed with the mixtures added in the first test. The tests with the iodin solution are repeated as in the first trial, and new limits are found be- tween which the exact value must lie. For example, at the expiration of ten minutes the paste to which 8.8 c.c. of the diastase solution is added may show a faint yellowish dextrin color, while that with 9.2 is colorless. We may go further and try a series of new dilutions, but practically it is not neces- sary. In fact, we cannot carry our readings to a much finer degree of accuracy, bcause of the difficulty of distinguishing between the effects of dilutions so near together, in many cases. In a case like the above illustration it is sufficient to take the mean of the last named dilutions, and calculate the results to the basis of one part of ferment and the starch converted by it. 6. We have recommended potato starch because it is pos- sible to obtain it in a satisfactory 'Condition of purity. The commercial corn starch, even after washing, does not appear to be suitable for the purpose. On microscopic examination the potato starch granules must appear clean and sharp. The working method is seen to be simple, and if all the commercial diastase ferments are tested in this way their practical value may be easily compared. Until something better is proposed we believe the scheme as outlined may be safely followed, and that it will be perfectly fair to all con- cerned. The above report was adopted by the Council, with the rec- ommendation that before publication it should be submitted to the manufacturers whose products had been examined. The replies were reported to the Council by the subcommittee, and the following supplemental report was submitted to the Coun- cil and adopted: This report has been submitted to the manufacturers of all of the articles described and opportunity given them to make any comment or criticism they saw fit to make. As might be 38 PROPAGANDA FOR REFORM expected, each firm was desirous of changing in some respect the wording of the report so far as it refers to the firm's products, but a careful consideration of these replies does not warrant the subcommittee in admitting the justness of any of the claims made. Parke, Davis & Co. .state that in testing their product, Taka Diastase, the reaction should be carried to the loss of blue color only, and claim that to digest to the loss of all color would work to their ferment "a very grave injustice." They say that "Taka Diastase is recommended, not for the rapidity with which it converts starch into maltose and dextrose, but rather for its usefulness in carrying cooked starch through the preliminary stages of digestion or hydrolysis with remark- able rapidity." The subcommittee fails to see the force of this argument, since what is desired in a diastase is con- version of starch into sugar. Besides this, Taka Diastase does not appear to be any more rapid in the preliminary stages than are some of the others, and in the advertising literature it is praised for its power of sugar formation, as are all the others. In the comments offered by Frederick Stearns & Co. objec- tion is made to the passage in the report in which we point out the discrepancy between the digestion of 200 parts by weight of starch in ten minutes and the conversion of 200 parts of starch into sugars. The firm promises to correct this discrepancy, which should have been done long ago. Fairchild Bros. & Foster object most strenuously to the posi- tion given Holadin in the table, and insist that by their method of testing, the product has a higher value than we give it. This, no doubt, is true, but the subcommittee is not concerned with the firm's method of testing, and must be allowed to employ its own, for the reasons pointed out in the report. The object is in part comparison, and for this uni- formity of methods is necessary. In this connection it should be noted that in the past the firm has strongly favored the adoption of a uniform method of testing diastase products. The manufacturers of Maltzyme write in a somewhat indefi- nite way of their disappointment in the findings of the report, but the letter calls for no special comment. W. A. Puckner, Secretary. (From The Journal A. M. A., July 11, 1908.) ' ECHINACEA Report of the Council on Pharmacy and Chemistry The Council has voted to reject several non-proprietary articles and has recommended that the reasons for their rejec- tion be given in The Journal; among these is echinacea. The COUNCIL REPORTS 39 following paper has been submitted by a subcommittee with the recommendation that it be published. This recommenda- tion was adopted. yy & Puckner, Secretary. Echinacea When this drug was first introduced, it was a typical nos- trum, with exaggerations regarding its therapeutic value that were somewhat more gross than usual. It was later adopted by the eclectic school without being freed from the stigmata of its origin. It was also pressed into use as the main ingre- dient of such proprietary preparations as echafolta, ecthol eusoma, etc. Efforts have been made to get the regular pro- fession to use it in these various forms. According to J. U. Lloyd (Pharm. Revierv, vol. xxii, p. 9-14) t the introduction of echinacea into eclectic medicine is due to the efforts of Dr. H. F. C. Meyer to increase the sale of Meyer's Blood Purifier, a secret remedy containing it. The following is a literal copy of the label on this nostrum: MEYER'S BLOOD PURIFIER DIRECTIONS This is a powerful drug as an Alterative and Antiseptic cases : Rheumatism, Sick Headache, Erysipelas, Dyspepsia, Old Sores and Biles, Open Wounds, Dizziness, Scrofula and Sore Eyes. In case of Poisoning by Herbs, <6 C.. take the double dosis, and Bites of Rattlesnakes take three ounces three times a day, until the swelling is gone. This is an absolute cure within 24 hours. After Lloyd had identified the plant, Meyer put the prepara tion out under another form with the following label: ECHINACEA ANGUSTEFOLIA This is a powerful drug as an Alterative and Antiseptic in all tumorous and Syphilitic indications; old chronic wounds, such as fever sores, old ulcers, Carbuncles, Piles, eczema, wet or dry, can be cured quick and active ; also Erysipelas. It will not fail in Gangrene. In fever it is a specific; typhoid can be adverted in two to three days ; also in Malaria, Malignant, Remittent and Mountain fever it is a specific. It relieves pain, swelling and inflam- mation, by local use, internal and external. It has not and will not fail to cure Diphtheria quick. It cures bites from the bee to the rattlesnake, it is a specific. Has been tested in more than fifty cases of mad dog bites in human and in every case it prevented hydrophobia. It has cured hydrophobia. It is perfectly harmless, internal and external. Dose.-One half to one fluid-drachm 3 or 4 times a day. Manufactured by H. C. F. Meyer, M.D'. Price, $ Pawnee City, Neb., U. S. A. Patent 40 PRO PA GA NDA FO li REFORM These absurd claims of an evidently ignorant man have passed into the more recent proprietary advertising matters and into much of the eclectic writings. Indeed, the seemingly impossible has been attained by even surpassing Meyer's all- but-all-embracing claims. Not content with endorsing echinacea as a positive and speedy "specific" for rattlesnake bite, syph- ilis, typhoid fever, malaria, diphtheria and hydrophobia, later enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus and exophthalmic goiter, and with the power of retarding the development of cancer. It is worth noticing-although it is not surprising-that these far-reaching claims have been made on no better basis than that of clinical trials by unknown men who have not otherwise achieved any general reputation as acute, discrim- inating and reliable observers. No attempt seems to have been made to verify these claims by accurate scientific methods, clinical or otherwise, although this could very easily have been done. Not one of the eulogistic reporters and exploiters seems to have considered it worth while to determine by the simplest control experiments whether the drug possesses any bacteri- cidal or antiseptic powers whatever.- It is therefore not very strange that discriminating physicians have failed to show much enthusiasm. One of the warmest endorsers of echinacea, C. S. Chamberlain (who later became the president of the Eusoma Pharmaceutical Company), complains that he has been unable to interest regular physicians in the remedy. He reviews the statements of previous authors and reports eight cases of infection, only two being acute or extensive, in which he used it with asserted success. In view of the lack of any scientific scrutiny of the claims made for it, echinacea is deemed unworthy of further consid- eration until more reliable evidence is presented in its favor. REFERENCES Meyer, H. F. C.: Eclectic Med. Jour., 1887; Goss: Chicago Med. Times, 1888; Hages: Eclectic Med, Jour., 1888; Shelly: Medical Gleaner, 1894 ; Lloyd, C. G. : Eclectic Med. Jour., 1897 ; Lloyd, J. U. : Eclectic Med. Jour., 1897 ; Lloyd, J. U.: Pharm. Review, xxii, 9-14 ; Schnitz, Elsie M. : Wis. Med. Recorder, 1898, ii, 202; White, J. N. : Texas Med. News, 1898-8, viii, 110-113; Stinson, J. C.: Therap. Gazette, 1900 ; Hale, E. : Lancet-Clinic, March, 1901; Thielen, B. F.: Echafolta, Its Uses in Dental Surgery, Dental Reg., 1903, vii, 462- 465; Gorse, C. A. : New Albany Med. Herald, 1903-4, xxii, 384; Chamberlain, C. S. : Louisville Monthly Jour. Med. £ Surg., 1904-5, xi, 219-223 ; Lancet-Clinic, 1905, M. S„ liv, 279-283 ; Ellingwood, F. ; Therap. Gazette, 1905, 3, S., xxi, 298-300; French, J. M. : Med, Brief, 1905, xxxiii, 537; Mathews, A. B. : Georgia Pract., 1905, i, 137-140.-(From The Journal A. M. A., Nov. 27, 1909.) COUNCIL REPORTS 41 ERPIOL (DR. SCHRADER) Report of the Council on Pharmacy and Chemistry The original rules of the Council governing the acceptance of articles have recently been modified, particularly by adopt- tion of Rule 10, which reads: "Unscientific and Useless Articles.-No article will be admitted which, because of its unscientific composition, is useless or inimical to the best interests of the public or of the medical profession." In view of these modifications, the Council is reconsidering the articles already accepted with the view of determining their compliance with the rules as amended. In line with this the Council reconsidered Erpiol (Dr. Schrader), manufactured by the William S. Merrell Chemical Company, and from the evidence given below concluded that one of the constituents, gossypin, is inert and its use unscientific. The Council there- fore voted that Erpiol (Dr. Schrader) be omitted from New and Nonofficial Remedies and authorized publication of the following report. W. A. Puckner, Secretary. Erpiol In consequence of the more thorough scrutiny now given by the Council to the therapeutic value of the remedies admitted to New and Nonofficial Remedies, the Council has reconsidered Erpiol (Dr. Schrader), previously accepted for New and Non- official Remedies. Erpiol (Dr. Schrader) is the name applied to capsules containing apiol, ergotin and gossypin, which are sold as an emmenagogue. The first two ingredients have a recognized value in the treatment of diseases of the female generative organs. The third, gossypin, is a preparation from cotton-root bark, belonging to the somewhat indefinite class of pharmaceutical preparations known as resinoids. Cotton-root bark (Gossypii radicis cortex, U. S. P.) has been credited by some with pharmacologic and therapeutic properties, similar to ergot, especially in its action on the uterus; experiments on pregnant animals do not confirm this view. Most authorities on gynecology either make no refer- ence whatever to the drug or ascribe little or no value to it. The preparations from the dried bark are inert. From reports made to him, Professor J. U. Lloyd concluded (Eclectic Med. Jour., 1876, xxxvi, 545) that a prime fluidex- tract of fresh cotton-root bark is an active therapeutic agent and deserving the attention of the medical profession, while that of the dry bark is inert and worthless. The gossypin on the market is made from the dried bark. Professor Lloyd, who is considered an authority on eclectic medicine, says: "Were it left to me to admit or exclude it 42 PROPAGANDA FOR REFORM by reason of its therapeutical position, I should exclude it, because, in my opinion, it has never been demonstrated, in clinical practice, to be worthy of any therapeutic recognition whatever." As the available evidence indicates that gossypin is an inert preparation, Erpiol (Dr. Schrader) was considered in conflict with Rule 10 and the Council has therefore voted that it be deleted from New and Nonofficial Remedies.-(From The Jour- nal A. M. A., June 3, 1911.) FALSE UNICORN (HELONIAS) Report of the Council on Pharmacy and Chemistry The Council voted to refuse to recognize false unicorn as a non-proprietary article and the following statements, sub- mitted by a subcommittee, were ordered published. W. A. Puckner, Secretary. False Unicorn-Helonias Helonias dioica, or more properly Chamcelirium luteum, is a plant, preparations of which enter into various proprietary mixtures for diseases of the female pelvic organs. In the advertisements of these preparations it is usually credited with hemostatic powers and is asserted to be a uterine tonic. There is practically no reference to this drug in reliable medical literature, and as there is no evidence worthy of credence to support the claims made for it, the drug was not considered deserving of a place in the Pharmacopeia. Hence, it may be regarded as a drug not worthy of attention of physi- cians.-(From The Journal A. M. A., Nov. 27, 1909.) FORMUROL Report of the Council on Pharmacy and Chemistry Formurol, Citrocoll and Aspirophen were submitted to the Council by the Cellarius Company of San Francisco. The manufacturers having failed to substantiate the claims they make for these products, the Council has voted that the prepa- rations be refused recognition. The Council also authorized the publication of the following report, which deals particu- larly with one of the preparations-Formurol. W. A. PuCKNER, Secretary. Formurol is the product of the Chemische Fabrik Falken- berg, Falkenberg-Gruenau, near Berlin, Germany. The Cel- COUNCIL HE PORTS 43 larius Company, San Francisco, acting as selling agents for the United States, submitted Formurol (along with Aspirophen and Citrocoll, also made by the same firm) to the Coun- cil, with the statement that it is "hexametbylentetramin- sodium-citrate," and that it has the following composition: "C0H7O7Na.C6H12N4." Zernik,1 who examined these products, reported that Aspirophen, Citrocoll and Formurol do not have the composi- tion that is claimed for them by the Fabrik Falkenberg. Formurol, he states, is not a definite chemical compound, but a mixture of hexamethylenamin and sodium citrate. The agents were advised of this fact by the Council and were asked to submit evidence to substantiate their claims. No such evidence was submitted. Since a compound having the composition that is claimed for Formurol is theoretically possible, the Council requested that the product be examined in the Association Laboratory to determine whether it still was the simple mixture reported by Zernik, or whether, perhaps, it now possessed the formula claimed for it. The following report was made by the Asso- ciation chemists: Formurol, as submitted to the Council, was in the form of tablets weighing about 1 gm. each and appeared to be composed of a fine white substance interspersed with some transparent particles. The tablets were readily soluble in water, were odorless and possessed a slightly acid taste. The aqueous solution responded to tests for hexamethylenamin, citrate and sodium. To determine whether hexamethylenamin was present in the free or the combined state, the method of Zernik was employed. This consists in the extraction of Formurol with chloroform, which dissolves out hexamethylenamin, leaving insoluble sodium citrate. As the use of the solvent, chloroform, would seem to preclude decomposition of such a hypo- thetical compound as "hexamethylenamin-sodium-citrate," the extraction of hexamethylenamin from Formurol may be taken to demonstrate its presence in the free state. That Formurol is not a compound of hexamethylenamin, but a mixture of hexamethylenamin and sodium citrate, was further indicated by the appearance of the crushed tablets described above. Further, under the low-power microscope the powder was found to be composed of trans- parent crystals and white opaque particles which apperared to be masses of minute crystals. When treated with 1. Zernik : Arb. a. d. Pharmazeut. Inst. d. Univ. Berlin, 1907, iv, 46. 44 PROPAGANDA FOR REFORM chloroform the transparent crystals dissolved, leaving the white masses intact, demonstrating the presence of two distinct substances, one soluble and the other insoluble in chloroform. It having been demonstrated that the residue obtained by evaporation of chloroform could not be weighed as hexamethylenamin, due to enclosed chloroform, the amount of this substance in the residue was deter- mined. The method used has been described in the Report of the Chemical Laboratory of the American Medical Asso- ciation, Vol. I, p. 55, and depends on the decomposition of hexamethylenamin by means of sulphuric acid to form ammonium sulphate and formaldehyd. From this solution the ammonia is liberated, distilled and determined2 by titration and from the ammonia found the amount of hexamethylenamin is calculated. By this method Formurol was found to contain (a) 35.42 per cent, and (b) 35.32 per cent., or an average of 35.37 per cent, hexamethylen- amin. The residue insoluble in chloroform was shown to consist essentially of disodium hydrogen citrate by determining3 the amount of sodium (Na) contained in Formurol. The percentage of sodium calculated from the amount of sodium sulphate found was (a) 11.38 per cent, and (b) 11.20 per cent., or an average of 11.29 per cent., equivalent to 62.50 per cent, disodium hydrogen citrate. As a check on this determination, the amount of material contained in Formurol which is insoluble in chloroform was determined.4 It was found to be (a) 63.23 per cent, and (b) 63.49 per cent., making an average of 63.36 per cent., and thus agreeing fairly well with the results obtained when the sodium content was assumed to 2. Determinations were made, following the details of the method described in the report of the Chemical Laboratory of the American Medical Association, Vol. I, p. 55, with the following results: (fl) 1.0769 gm. Formurol yielded an amount of ammonia requiring 10.96 c.c. normal sulphuric acid for neutralization, indicating the presence of 0.3815 gm. or 35.42 per cent, hexamethylenamin. (b) 1.1178 gm. Formurol required 11.36 c.c. normal sulphuric acid, equivalent to 0.3952 gm. or 35.32 per cent, hexamethylenamin, making an average of 35.37 per cent. 3. Sodium was estimated by converting to sodium sulphate in the usual way, with the following results: (a) 1.0319 gm. Formurol yielded 0.3621 gm. sodium sulphate, equivalent to 11.38 per cent, sodium. (6) 0.8783 gm. Formurol yielded 0.3035 gm. sodium sul- phate, equivalent to 11.20 per cent, sodium ; average, 11.29 per cent., equivalent to 62.50 per cent, disodium citrate (C6H6O7Na2 + H2O). 4. The matter insoluble in chloroform was determined by weigh- ing Formurol to a fared filter, which had been washed with chloro- form and dried at 100 degrees, and percolating with chloroform till the dried filter and contents became constant in weight. By this method (a) 1.0769 gm. Formurol yielded 0.6826 gm. or 63.23 per- cent. matter insoluble in chloroform; and (b) 1.1178 gm. Formurol yielded 0.7079 gm. or 63.49 per cent, insoluble matter; average, 63.36 per cent. COUNCIL REPORTS 45 be disodium hydrogen citrate. From this analysis it appears that Formurol is not a definite compound of hexamethylenamin and sodium citrate, but instead is a mixture of these substances consisting approximately of hexamethylenamin 35.37 per cent, and sodium acid citrate (disodium hydrogen citrate) 63.36 per cent., practically a mixture of 1 part hexamethylenamin and 2 parts sodium acid citrate. These results agree with those reported by Zernik5 and show that the product now, as then, is not true to claims. In view of the findings of the laboratory, it is recommended that Formurol be refused recognition. As the exploitation of well-known remedies under false and misleading names is detrimental to the progress of medicine, it is recommended that publication of this report be authorized. Editorial Note: This report illustrates once more the value of the Council on Pharmacy and Chemistry and the Chemical Laboratory to the medical profession. Before the Council was organized there was no agency to protect the phy- sician's interests in the matter of pharmaceuticals. Under the old rggime Formurol would have been heralded as a new "synthetic" of the most approved made-in-Germany type- and the claims would have gone unchallenged. To-day its status is made clear and the profession is informed. Only those who have closely studied the question can realize what a wonderful power for commercial probity the Council has proved. Under the laissez faire system of the past, many large pharmaceutical firms gave little attention to the accuracy of the claims made for their products. If the advertising gave good "pulling" results, that was all that was asked' or expected. Within the past five years a wonderful change has taken place in this regard, and firms of the better class have so modified their advertising as to make it not only con- servative in tone, but to approximate scientific accuracy?- (From The Journal A. M. A., Jan. 21, 1911.) GARDNER'S SYRUP OF HYDRIODIC ACID The following report on Gardner's Syrup of Hydriodic Acid was submitted to the Council by a subcommittee: This product was first taken under consideration in Feb- ruary, 1906. Reference to several committees was neces- sary, on account of the peculiar claims for the pharma- 5. Therap. d. Gegenw., February, 1909. 46 PROPAGANDA FOR REFORM ceutical, and especially the therapeutic, superiority of this preparation. At this time, as the Council did not have the necessary facilities for investigating therapeutic claims, the product was approved by the Council. Since this time, however, the manufacturers have laid especial stress in their advertisements on some highly improbable claims, stating, for instance, that this Syrup of Hydriodic Acid possesses "all the advantages, with none of the objectionable symptoms caused by potassium iodid, or other forms of iodin medication." To one with even an elementary knowledge of chemistry, the absurdity of this statement should be evident. The alkaline re- action of the tissues makes it impossible that hydriodic acid should persist as such in the body. In fact, the iodin must circulate in precisely the same form, whether administered originally as potassium iodid or as hydro- gen iodid. The qualitative identity of the therapeutic actions is further proof of this fact, were such needed. Since the most important objectionable symptoms of iodid medication arise after the absorption of the drugs, and since hydrogen iodid is conceded to be readily ab- sorbed, it is evident that these symptoms must be equally liable to occur with hydrogen iodid as with potassium iodid, provided that equivalent doses of iodin are adminis- tered. An apparent difference in clinical results would arise if the one drug is habitually given in smaller doses than the other. Since, however, the iodin is present in the body in precisely the same form, whether it is admin- istered as a hydrogen iodid or potassium iodid, it is evi- dent that a given degree of therapeutic effect would cor- respond to an identical tendency to iodism, whichever drug was used. If, as appears to be the case, the use of hydri- odic acid is commonly restricted to those cases in which only minimal doses of iodin are required, the relative in- frequency, or even absence of symptoms with such doses would not prove that the drug itself is less apt to cause them than is the potassium salt. These facts are in reality self-evident; but since the Council now has the proper facilities for obtaining the views and experiences of clinicians, it voted to submit the statement in question to its staff of clinical consultants, and to be guided by their advice. OPINIONS OF THE CLINICAL STAFF The following is an epitome of the replies of the eleven members of this staff who had used the article or who expressed an opinion to the questions sent out by the Council: COUNCIL REPORTS 47 1. Query: "Do you think it possible that such a prepa- ration could be devoid of the usual effects of iodin prepara- tions?" Eight reply that they consider this, a priori, impossible; three stamp the statement as highly improbable, but do not care to say that it would be impossible. One of the correspondents remarks: "While distinctly taking the position that under many conditions we must accept clinical results which we find not explainable by our theo- retical knowledge, where the conditions are so simple as in this ease and where we know that the iodin, whether administered as hydrogen iodid or potassium iodid, must behave in the same way, after absorption, I believe that no properly educated and correct thinking physician can or will, after due consideration, fail to reject the claims of superiority made by the proprietors of this preparation." 2. Query: "Would you consider it necessary to make clinical experiments to settle this question ?" Seven of the correspondents consider this superfluous; four of these have had some experience with the article. Four, who have not used this product, consider a clinical test advisable. Under Query 3 we discuss the results of such tests. 3. Query: "When using Gardner's Syrup of Hydriodic Acid, have you ever noticed from it any of the objection- able effects of iodin preparations?" Six of the correspondents have not used it. or are un- certain whether or not they used the product made by Gardner. One correspondent remarks: "Never used it. Repelled by claims of superiority which exaggerate dis- advantages of potassium iodid and overlook the small amount of iodin used in the preparation advertised." The five clinicians who have prescribed the preparation report as follows: 1. Objectionable iodin effects in two cases, both patients being intolerant of all iodin prepa- rations. 2. Has only prescribed it once or twice, but thinks he has seen iodism in one case, some years ago; does not recall clearly. 3. No; but has used this make very little, and then always in very small but continued doses. 4. No, but always used it in small doses. 5. Yes, several cases in children; typical coryza, etc., with doses of three drams three times a day. Conclusions : It appears that typical iodism occurred in several cases, after doses corresponding to 10 grains or less of potassium iodid per day, and this in a rather lim- ited clinical material. Objectionable iodin effects are, therefore, not uncommon. Several correspondents remark that the relative infrequency of iodism is easily explain- 48 PROPAGANDA FOR REFORM able by the fact that syrup is rarely employed in condi- tions which demand an active iodin medication and that it is, therefore, always taken in small doses. In fact, the main if not the only point of superiority of the syrup appears to be in its flavor. These clinical opinions and experiences, therefore, are in complete agreement with the judgment of the commit- tee, namely, that the therapeutic claims made by the manufacturers for this article are exaggerated and mis- leading. OTHER MISSTATEMENTS The above is by no means the only misstatement in the printed matter issued by this manufacturer. In the publication, "The Applications of lodin," issued in 1907, there occur the following misleading statements which, since they refer to plainly chemical facts, did not require submission to the clinical staff: That the administration of potassium iodid after meals greatly impairs its physiologic action "by its chemical union with the various food products" (Page 19). So far as the committee knows, potassium iodid does not combine with the food products in the stomach. "Iodid of potassium, having an alkaline reaction, neu- tralizes the hydrochloric acid in the gastric secretions, causing indigestion, loss of appetite and depression" (Page 19). The United States Pharmacopeia states, under Potassii lodidum: "Its aqueous solution is neutral or has a slightly alkaline reaction on litmus paper." The slight occasional alkalinity would be physiologically insignifi- cant, and it is absurd to claim that this alkalinity causes "indigestion, loss of appetite and depression." "The dose of iodid of iron is so small that the amount of iodin contained therein is of little advantage" (Page 19). As a matter of fact, the pharmacopeial average dose (1 c.c.) of the Syrup of Iodid of Iron contains as much iodin (0.85 grains) as a teaspoonful of Gardner's Syrup of Hydriodic Acid (0.83 grains). "In hydriodic acid the iodin is in combination with hydrogen, one of the elements of the natural secretions of the body, and is, therefore, in physiologic harmony" (Page 21). No comment is needed. It is implied elsewhere (Page 29) that potassium iodid decomposes more readily, with the liberation of iodin, than does hydrogen iodid. This is contrary to the prevail- ing opinion, and would require definite evidence before it could be accepted. It is also stated the large doses of potassium iodid in syphilis are necessary, because the gastric decomposition prevents complete absorption. This is certainly untrue, for potassium iodid is absorbed almost quantitatively. COUNCIL REPORTS 49 These, and numerous other misstatements, constitute violations of Rule 6; and it is, therefore, recommended that Gardner's Syrup of Hydriodic Acid be removed from the list of remedies approved by the Council; it is further recommended that this report be published. The Council postponed final action on the report pending its submission to R. W. Gardner. This having been done, and the reply of Mr. Gardner submitted to the Council, the above report was adopted and ordered published. W. A. Puckner, Secretary. (From The Journal A. M. A., Nov. 11), 1908.) GLYCOZONE Report of the Council on Pharmacy and Chemistry, with Comments A number of specimens of Glycozone purchased in the open market were examined by a sub-committee. The product was found to be a mixture of approximately 90 per cent, glycerin, 5 per cent, glyceric acid, a small amount of water and traces of undetermined matter. The absence of hydrogen peroxid or other peroxids was demonstrated. In its report the sub-committee held that: (1) The name of the product is objectionable and misleading; (2) the state- ments made in regard to its composition also are misleading; (3) the claims for its therapeutic value are exaggerated and untrue. Since the objectionable statements have been given wide publicity among physicians as well as among the laity, the sub-committee recommended that attention should be called to the matter in The Journal. The report of the sub-committee was adopted by the Council. W. A. Puckner, Secretary. Comment:-While the name gives the impression that ozone or some similar substance is an essential constituent of Glycozone, or else that the preparation is a compound or de- rivative of ozone, and while the earlier advertisements stated that Glycozone was "glycerin combined with ozone," the ex- amination made by the Council shows that there is no basis of fact for such inferences. in the advertisements the "chemical formula" C3H8O4 + C3H8O3 appears unde" the word Glycozone. From the Council's report it is apparent that C3H804 stands for glyceric acid and the C3H8O3 for glycerin, and, therefore, indicate the chief con- stituents of Glycozone. Few, doubtless, would recognize the 50 PROPAGANDA FOR REFORM first formula as being that of glyceric acid, a product prac- tically unknown in medicine, nor would many associate glycerin with the second. The evident intent is that physi- cians should accept the formula as a badge of respectability. According to the label on a trade package, Glycozone is "prepared only by Charles Marchand, chemist," and is "an absolute cure for dyspepsia, catarrh of the stomach, ulcer of the stomach, heart-burn," etc. The label further reads: "This remedy is positively harmless. By destroying the microbian element in the stomach it prevents the fermenta- tion of food and stimulates digestion." An examination of medical literature fails to reveal any basis for these claims. Much-reduced photographic reproduction of one of the older Glycozone advertisements. Attention is directed to the false claim that this nostrum is "glycerin combined with ozone." While glycerin possesses some antiseptic properties, it is evi- dent that the glycerin which constitutes 90 per cent, of this remedy is not the agent that gives the glycozone such phe- nomenal virtues. General literature contains nothing that would indicate that glyceric acid in any quantity, with or without glycerin, possesses these miraculous properties. If by "microbian element" is meant microbic organisms, the statement is without foundation. There is notnmg in this product which possesses these bactericidal powers. The circular which accompanied a trade package, envelopes the preparation in an air of mystery. Derivation from, or close relation to, ozone and hydrogen peroxid is vaguely hinted COUNCIL REPORTS 51 at, without definite assertion. Thus, the chief therapeutic properties of glycozone and hydrozone are compared as follows: "Hydrozone instantly destroys the microbian element, leaving the tissues beneath in a healthy condition." "Glycozone acts more slowly, but not less certain as a stimulant to healthy granulations." There is no similarity between the action of hydrozone, which is a hydrogen peroxid preparation, and glycozone, which consists of a mixture of glycerin and glyceric acid. The rep- resentation is false and misleading. The following statement, also, is an unwarranted exaggeration of the facts: "As an internal medication in fermentation of food, catarrhal and inflammatory conditions of the stomach, and intestinal disor- ders, its action is prompt and effective, giving immediate relief to the patient." The following is another illustration of the vague state- ments made: After asserting that glycozone is hygroscopic and that it will deteriorate by absorption of water unless securely corked, it is stated that "Its healing properties increase with age." Whatever mysterious ingredient there may be present in this mixture to justify the statement that the healing proper- ties increase with age can only be conjectured. To humbug the patient further he is advised to use only a "silver, glass or hard rubber spoon."-(From The Journal A. M. A., June 5, 1909.) LABORDINE Report of the Council on Pharmacy and Chemistry, with Comments Labordine is advertised to physicians as having the fol- lowing composition: Per cent. Apium Graveolens (true active principle) "Process- Laborde" 35% Gaultheria Fragrantissima (true active principle) "Proc- ess-Laborde" 25% Acete Amide-Phenyle 15% Quinina 1% Benzoyl-Sulphyonic-Imide 23% It is stated to be a "vegetable antipyretic;" that it "reduces temperature without heart depression," and physicians are warned to "avoid acetanilid poisoning and danger from other coal-tar antipyretics." While the "formula" and the statement just quoted are sufficient evidence of the fraudulent character of the product, yet an abstract of the reports of the chemists who analyzed it is given to further demonstrate its character. 52 PROPAGANDA FOR REFORM Taking the average of the reports of analyses, Labordine contains: Per cent. Acetanilid 37.9 Free salicylic acid 6.9 Quinin present Saccharin not found Corn starch present Milk sugar 34.7 The report of analysis only makes apparent that Labordine is not what it is claimed to be. While it is claimed to con- tain 23.25 per cent, saccharin, this substance was not present, or mere traces only. While, in a disguised way, it is stated to contain 15.125 per cent, acetanilid, it contained nearly 40 per cent. The alleged constituents are explained in the comments sub- stantially as follows: "Apium Graveolens (true active prin- ciple) 'Process-Laborde,' " is probably powdered celery seed. One chemist finds it has the characteristic odor of celery and microscopically the characteristic structure of seeds in gen- eral. If celery seed has an active principle it has nevei' been isolated and nothing is known as regards its therapeutic value. "Gaultheria Fragrantissima (true active principle) 'Process-Laborde' " is probably ordinary salicylic acid. One analysis showed salicylic acid to be present to the amount of about 7 per cent. Whether salicylic acid could be considered as the true active principle of the plant named is dubious. The third and most important ingredient in this "purely vege- table antipyretic" is announced as acete amide-phenyle, which is an attempt to Frenchify a scientific name for acetanilid, which is not usually regarded as a vegetable product. Analy- sis shows that this forms about 37.9 pei- cent, of the product, or 1.89 grs., in a five-grain tablet, and this approximately two grains of acetanilid is the only practical therapeutic agent. The important ingredient called benzoyl-sulphyonic- COUNCIL REPORTS 53 imide is simply saccharin, which could not be found on analy- sis. This is a fair sample of the nostrums and of the methods of exploiting them. The bitterly humiliating fact about the whole business is that a preparation, advertised under such palpably misleading claims, could actually be advertised in medical journals, even in journals of a supposedly high scien- tific standard, and could be bought and prescribed for years by supposedly intelligent and conscientious physicians. It is not supposed that every physician should be enough of a chem- ist to detect the ridiculous discrepancies between the published formula and the therapeutic claims made for such a mixture. But that members of a supposedly learned profession should fail to have enough interest in the preparations they prescribe for their confiding patients to find out that acetanilid is being masked under an obsolete and little used name, that only saccharin is hidden under an imposing polysyllable designa- tion; that the so-called "active principles Process-Laborde" (whatever that may be), is only equivalent to % grain of salicylic acid in a 5-grain tablet, and that the advertising matter sent out for years by this company contained absolute falsehoods regarding the composition and therapeutic benefits of its preparation, *is certainly just cause for shame and humiliation. If a physician, knowing the composition of Labordine, wishes to prescribe it and prescribes it intelligently, he has a perfect right to do so. If he wishes his patient to have 2 grains of acetanilid, 1/20 of a grain of quinin, and 1/3 of a grain of salicylic acid, and considers a mixture of ground celery seed, starch and milk sugar as a proper vehicle for this medication, no one will question his right to administer it. No physician, however, has any right, either moral or pro- fessional, to prescribe a preparation, concerning the ingredi- ents of which he knows absolutely nothing.-(Abstracted from The Journal A. M. A., March 30, 1007.) LACTOPEPTINE Report of the Council on Pharmacy and Chemistry-with Some Comments Thereon The following report was submitted to the Council by a sub- committee : We have devoted considerable time to the investigation of Lacto- peptine (powder) and report as follows: The label on the package contains this statement: "Lactopeptine contains the five active agents of digestion-pepsin, diastase (veg. 54 PROPAGANDA FOR REFORM ptyalin), pancreatin, lactic acid and hydrochloric acid-combined in the proper portion to insure the best results." Examinations demonstrated that more than 90 per cent, of Lac- topeptine is milk sugar. The amount of pepsin contained in Lactopeptine is somewhat less than 10 per cent, of official pepsin. Careful examination failed to show the presence of either dias- tase or pancreatin. Examination demonstrated a minute trace of chlorid only, there- fore the preparation does not contain any appreciable amount of hydrochloric acid. The amount of lactic acid, calculated from the quantity of potassium hydroxid required for neutralization, was found to be 3 per cent. From the above it is evident that Lactopeptine (powder) is at least no more efficient as a digestive agent than the ordinary Saccharated Pepsin, official in the 1S80 U. S. Pharmacopeia, but replaced in the present Pharmacopeia by the more active and dependable Pepsin. These findings were submitted to the manufacturers of Lacto- peptine, the New York Pharmaceutical Association, who, in their reply, stated, "Regarding the assertion that Lactopeptine does not contain pancreatin and diastase, we herewith confirm and reassert our statement that Lactopeptine is and has always been manufac- tured in accordance with the published formula and that the fer- ments referred to exist in the preparation as stated in the formula." In view of these reasserted claims regarding the composition of Lactopeptine, another specimen was purchased in the open market. Its examination showed that it vjas of even pborer quality than the first specimen examined. The tests not only failed to show the presence of diastase or pancreatin, but also failed to show the presence of any appreciable amount of pepsin. From these experiments your subcommittee must conclude that Lactopeptine contains but small amounts of pepsin, that it contains no hydrochloric acid or mere traces only, and that it contains neither diastase nor pancreatin. Hence, the statements made by the manufacturers in regard to the composition of Lactopeptine are incorrect. Since the composition of Lactopeptine is not given by the manufacturers, but, instead, corresponds to a weak sac- charated pepsin, it is evident that the claims made as to its ther- apeutic value are unwarranted, exaggerated and misleading. It is, therefore, recommended that Lactopeptine be not approved. In view of the wide publicity given to the claimed composition and therapeutic value of the article, it is further recommended that this report be published. The recommendations of the subcommittee were adopted by the Council, and in accordance therewith the report is pub- lished. W. A. Puckner, Secretary. Reduced to a few words, the above report shows that-what- ever the manufacturer may have put into it-Lactopeptine as it exists on the market was found by the subcommittee to be only equal to a weak saccharated pepsin, which has but one- tenth the digestive power of the official pepsin and that Lacto- peptine at times is inert. COL) FOIL REPO UTS 55 that the subcommittee which examined Lactopeptine could find neither diastase nor pancreatin was to be expected, since it has been demonstrated repeatedly that those ferments are destroyed by pepsin in the presence of acid. The examination shows that in the absence of solvents the presence of lactic acid still enables the destruction of pancreatin and diastase. That the manufacturers should have attempted to manufacture such an impossible product, and that the medical profession should have accepted it, is not creditable to either party con- cerned. That the subcommittee should fail to find the hydrochloric acid claimed to be contained in the product was a foregone conclusion. If it is remembered that ordinary hydrochloric acid is a solution of hydrogen chlorid in water and that hydro- gen chlorid itself is a gas, the absurdity of the claim that it is contained in a dry powder is apparent. It is astonishing that physicians should so long have used a product about whose therapeutic value extravagant claims have been made, when the very statements in regard to its composition should have condemned it.-(From The Journal A. M. A., March 16, 1907.) A Further Report on the Digestive Power of Lactopeptine. Dr. Charles II. Miller, assistant professor of pharmacology, Northwestern University Medical School, has voluntarily con- ducted some experiments for the purpose of learning whether or not Lactopeptine Powder is effective either as an amylolytic or a proteolytic ferment. From his experiments he concluded: "Lactopeptine is apparently equivalent in proteolytic power to the Pepsinum Saccharatum of the U. S. P., 1890, which was a 10 per cent, preparation, and like it, Lactopeptine is only active in acid media. It is devoid of active enzymes other than the pepsin, and while the powder is feebly acid in reac- tion, no activity could be shown when water was the medium employed."-(Abstracted from The Journal A. M. A., March 23, 1907.) LIQUID NITROUS OXID Report of the Council on Pharmacy and Chemistry The referee of the Council appointed to report on the com- position of liquid nitrous oxid as found on the market and to make recommendations as to its inclusion with New and Nonofficial Remedies, submitted the following report: The Section on Stomatology, at the 1909 session of the American Medical Association, having recommended the inclu- 56 PROPAGANDA FOR REFORM sion of Liquid Nitrous Oxid with the U. S. Pharmacopeia, the Council voted to describe this product with New and Nonofficial Remedies until such Pharmacopeial recognition had been secured. This action having been decided on, it was necessary to provide a standard of purity for this substance. Correspondence with those who make liquid nitrous oxid, as well as with those who use it, brought out very little infor- mation as to what degree of purity should be required. It therefore became necessary to examine the product as it was found on the market. Prof. Warren R. Smith of Lewis Institute, Chicago, kindly offered to cooperate with the Council and to make an exami- nation of liquid nitrous oxid. The referee herewith trans- mits the very thorough report regarding the composition of commercial liquid nitrous oxid which has been made by Pro- fessor Smith in collaboration with Edwin D. Leman. The referee recommends that the Council express its appreciation for the work, and that it request publication of the report in The Joubnal. The referee further recommends that the description of liquid nitrous oxid submitted herewith be adopted for inclusion with New and Nonofficial Remedies. This report was adopted by the Council, and in accordance therewith the examination of Smith and Leman is pub- lished below, and the description of liquid nitrous oxid appears with New and Nonofficial Remedies on another page of this issue of The Joubnal. The increasing use of nitrous oxid gas, not only as the sole anesthetic in minor operations, but as a preliminary to ether or chloroform anesthesia, makes the adoption of a standard of purity for this substance highly desirable. W. A. Pucknek, Secretary. The Purity of Nitrous Oxid PBOF. WABBEN B. SMITH AND EDWIN D. LEMAN Nitrous oxid is commonly sold in cylinders containing 25 ounces of the liquid, which is approximately equal to 100 gal- lons of the gas under ordinary conditions. We have analyzed four cylinders of this material from different makers. Three of these samples were purchased in the open market, and the other was supplied to us through the courtesy of the dealer. We find that all these samples contain nitrogen as the princi- pal impurity, that two of them contain oxygen and that one contains oxygen and carbon dioxid. All samples were tested qualitatively by passing from 2 to 4 liters of the gas through solutions of barium hydroxid, lit- mus, silver nitrate, potassium iodid and starch and Nessler's reagent, with negative results in every case except the one which showed carbon dioxid. These results proved that the samples were free from acids, chlorin, the higher oxids of COUNCIL REPORTS 57 nitrogen, ammonia and various other less probable impurities. The findings in the quantitative analysis are given below. These results cannot be taken as representing the contents of the cylinders with the same degree of exactness than can be obtained in the analysis of other materials of different nature, because, aside from the ordinary difficulties in the analysis of a gaseous mixture, the problem is complicated by the fact that the impurities (oxygen and nitrogen) are apparently held in solution in the liquid nitrous oxid and as the gas is drawn off, they tend to escape from the solution at a more rapid rate, proportionally, than the nitrous oxid. The result is that the first portions of gas drawn from the cylinders are much more impure than the later portions. From a product containing originally 90.1 per cent, of nitrous oxid, samples varying as widely as from 87.2 per cent, to 98.5 per cent, have been obtained. The greater part of the nitrogen escapes with the first half of the gas, but the oxygen and a small part of the nitrogen persist throughout. This possibility of variation in the'composition of the gas as drawn from the cylinders should be known and reckoned with in the administration of the gas. It seems, also, to make a difference whether the sample of gas drawn for analy- sis is that which has been standing for some time in contact with the liquid, or is that which comes from the liquid after the gas in the upper part of the cylinder has been drawn off. This variation complicates the analysis, but is hardly enough to be of significance in the administration of the gas. The results given below are either' averages of those obtained from samples drawn at intervals during the escape of the entire quantity of gas from the cylinder or of material drawn directly from the liquid itself, methods which we have proved to give results practically identical. Percentage of No. 1.* No. 2.* No. 3.* No. 4.* .Vitrous oxid 95.4 93.4 95.8 96.1 Oxygen 0.0 1.4 1.1 00.1 Nitrogen 4.6 5.2 3.1 3.5 Carbon dioxid 0.0 0.0 0.0 0.3 * 1 = Johnson & Lund ; 2 = Ohio Chemical and Mfg. Co. ; 3 = The Lennox Chemical Co. ; 4 = S. S. White Dental Mfg. Co. Carbon dioxid was determined by absorption with alkali, oxygen with alkaline pyrogallol, nitrous oxid by explosion with hydrogen and nitrogen by difference.-(From The Jour- nal A. M. A., Aug. 12, 1911.) PROPAGANDA FOR REFORM 58 MEAT AND BEEF JUICES* Report of the Council on Pharmacy and Chemistry The following was submitted to the Council by a subcom- mittee : To the Council: While meat extracts contain only traces of coagulable proteids and have little food value, meat juices are prepared by a process which ensures the presence in the finished product of considerable quantities of coagulable proteids and they therefore have considerable value as foods. Many preparations which are sold as beef juices or meat juices have no right to these designations. Since the public and physicians are likely to be misled by the names given to these products and by the false claims which are made for them as foods and depend on them in the nourishment of the sick, it is important that their composition and their value as foods should be known. In the following report is presented the results of an examination of some of the commercial products, found on the American market. The report shows that Wyeth's Beef Jiiice (John Wyeth & Bro., Philadel- phia), Bovinine (The Bovinine Co., New York), Carnine (Carnine Co., Fougera & Co., New York), and Valentine's Meat Juice (M. J. Valentine, Richmond, Va.) are sold under names which are incorrect, that their composition is not correctly stated by the manufacturers and that false and misleading statements are made in regard to their value as food. It is Recommended that the products named be refused recognition for conflict with rules 1, 6 and 8. Since these preparations are typical of many others on the market, and as their use is a menace to the public health it is recommended that the report be published. This report was adopted by the Council. W. A. Puckner, Secretary. Beef or meat juices are clearly to be distinguished from beef or meat extracts. The word "juice" applies solely to the fluid portion remaining in frdsh meat after proper cooling and storing and may be obtained by pressure or diffusion with or without a low degree of heat. Under heavy pressure freshly chopped meat will yield from 25 per cent, to 40 per cent, of a thick reddish juice and if the meat is previously frozen or heated to G0° C., as much as 50 per cent, may be obtained. This gives some idea as to the probable cost of preparing beef juice at home. The chief characteristics of meat juice are the presence of a considerable proportion of coagulable protein * See also the article "Meat Extracts and Mea,t Juices," page 258. COUNCIL REPORTS 59 and a low content of meat bases. The above represents the nature of these commodities as usually understood by the medical profession as is clearly shown by this quotation:1 "One or two teaspoonfuls of this (meat juice) are added to a teacupful of cold or warm water, which, however, must not be boiling, or otherwise the albumin would be coagulated, but it may, however, be sufficiently warm to drink comfortably." Beef juice is considered by some physicians of much dietetic service and believed to represent liquid food in concentrated form. W. 0. Atwater,2 relative to this product, says: "Beef juice obtained from the best steak which has been merely warmed through over the coals and then entirely de- prived of soluble substance by a screw press, is undoubtedly the most concentrated of the liquid foods." The latter authority gives a number of analyses of beef juices prepared under known conditions. DEFINITION OF MEAT JUICE Meat juice is defined by the standards committee of the Association of Official Agricultural Chemists as the fluid por- tion of muscle fiber obtained by pressure or otherwise, and may be concentrated by evaporation at a temperature below the coagulating point of the soluble protein. The solids con- tain not more than 15 per cent, of ash, not more than 2.5 per cent, of sodium chlorid (calculated from the total chlorin present), not more than 4 nor less than 2 per cent, of phos- phoric acid (P205), and not less than 12 per cent, of nitrogen. The nitrogenous bodies contain not less than 35 per cent, of coagulable proteins and not more than 40 per cent, of meat bases. Meat juices of commerce are supposed to be made by sub- jecting properly prepared meat to heavy pressure with sub- sequent concentration of the juice in vacuo at a low tem- perature. The latter is necessary because if the temperature is raised to any material extent the valuable coagulable, sol- uble proteins referred to above, are precipitated and lost. In order to establish a basis of comparison relative to the com- position of natural raw beef juice a number of samples were prepared under known conditions and submitted to analysis. The results contained in the subjoined table clearly show that meat juices made under known conditions vary according to 1. Brunton, Sir Lauder: "Disorders of Assimilation, Digestion, etc.," p. 183. 2. Bull. No. 21, U. S. Dept. Agricult., Office of Experiment Stations. 60 PROPAGANDA FOR REFORM the mode of preparation, but it is evident that practically one- half of the nitrogen is present as coagulable protein. FOOD VALUES In order to arrive at the food value of any commodity it is necessary to consider its chemical composition, available poten- tial energy, absorbability, etc. On referring to the analytical table it will be found that the amount of inorganic material in meat juices Nos. 7 and 10 is unduly high. It appears that sodium chlorid, per se, has been added to both Bovinine and Wyeth's Beef Juice probably as a preservative in the latter and for condimental purposes in the former. The relative and absolute proportions of phosphatic material in both products is excessive. The other constituents present in the ash are those usually found in meat products. The amount of sugar and glycerin in Carnine is interesting. These agents may be added for preserving purposes but the resulting product, on account of its syrupy appearance, leads to the belief and is so represented, that it is a concentrated food. Glycerin is also present in Bovinine and Valentine's meat juice. Bovinine in addition contains about 8 per cent, alcohol. The total nitrogen content of the trade products excepting Carnine, is greater than the amount of nitrogen present in meat juices proper, but the relative amount of nitrogen present as coagulable protein-the valuable part of meat juice-is much greater in the latter. In fact, the amount of coagulable protein present in Valentine's Meat Juice may be considered nil, which indicates that an unduly high temperature is used in its preparation. In this connection it should also be noted that even a moderate elevation of temperature influences the chemical composition of meat juices. For example, the coag- ulable matter present in Nos. 3, 4 and 5, is approximately one-half that present in Nos. 1 and 2, which appears to indi- cate that the best product can be made without the use of any heat whatever. Several of the trade products, namely Nos. 7, 8 and 9, contain about as much coagulable material as meat juice made by heating beef to 60 C. According to the formula appearing in a circular of the Bovinine Company, a part of the coagulable matter is present in the form of egg albumin, but the company claims egg albumin is not used at present. In the ease of Carnine, the coagulable matter appears to be introduced by the use of blood itself. The exact nature of the coagulable protein matter in Wyeth's Beef Juice has not been ascertained. It is well-known to manufacturers and physiologic chemists that it is practically impossible to manu- go CD ' CD o P saw 6 s *s • 3 gio ci.g Cl o LO (M CQ is Si S i ft o p g ■ cd • a QJ .Q O QI . ft© 0-2CO C> • CD a 3 Name of Preparation. 01 o ci □organ! matter. Sj ss 2 x a°O hg 2 Ither -act, G 1 and termir S a a> ci „ M a o 3 Mo * o a^; CD ~ Other tein (N x 6. ' m .«£■ aS ui S a o CD O a 1 w o § o Sgt "So's a ® /. > ►-< Mo O Oio " a CD io " cs • Per Per Per Per Per Per Per Ter Cent. Cent. Cent. Cent. Cent. Cent. Cent. Cent. ^Chuck beef, cold pressed. . 86.85 1.86 .20 .31 1.32 1.74 6.13 2.94 .90 217.68 2.52 5 Round beef, cold pressed.. 85.76 1.53 .12 .37 .75 2.08 8.56 2.37 1.03 262.32 2.88 o Chuck beef pressed at 60 C. 91.90 1.29 .19 .29 .81 1.09 2.56 2.50 .84 121.44 2.35 1 Chuck beef pressed at 60 C. 89.56 1.27 .16 .37 2.98 1.09 3.00 2.63 .56 135.12 1.57 a Round beef pressed at 60 C. 90.65 1.36 .16 .36 2.09 1.16 4.25 .31 1.34 109.44 3.75 o Chuck beef heated 6 hours ci before pressing 60-100 C. 98.11 .39 .05 .12 .25 .24 1.00 .25 24.00 .70 Beef Juice, John Wyeth & UI Bro., Philadelphia, Pa. . 58.84 16.21 6.71 3.27 12.51 3.15* 2.88 3.56 6.00 154.56 16.8 CD Bovinine, The Bovinine Co. - P 75 W. Houston St., New o York City 80.403 1.55 1.05 .09 3.64= 2.36 3.38 10.75 .28 339.12 .78 Carnine Co., Lefranco, 1 Paris, France ; Imported "S by Fougera & Co., Agts., p New York City 24.80* .86 0.09 0.33 68.94® .96 2.25 2.56 .59 115.44 1.65 ft Meat Juice, M. J. Valen- V tine, Richmond, Va . ... 57.64 10.26 1.77 3.41 20.417 3.062 .19 5.44 6.06 135.12 16.97 1. Including .20 per cent, as NH3; 2, including .22 per cent. NH 3; 3. 8.17 per cent alcohol found ; 4, vacuum 70 C. : 5. 3.1 per cent, glycerol found ; 6, 47. 50 per cent, cane sugar-14.2 pei- cent glycerol found ; 7, 8 per cent, of glycerol found. The several samples of beef juice were prepared from practically fat free, finely comminuted, chuck and round peer, first by pressure at the ordinary temperature; second, by heating the prepared meat for several hours at 60 C., then submitting to pressure. Sample No. 6 was made from chuck beef, prepared as above, by heating six hours at from 60 to 100 C., and expressing after cooling. It is not a beef juice proper but was prepared, analyzed and added to the list for information. Its composition resembles several commercial articles closely. A number of products represented and sold as meat juice in the United States were analyzed and the results recorded in the accompanying table. COMPOSITION OB' MEAT JUICES 62 PROPAGANDA FOR REFORM facture a genuine meat juice possessing a reasonable amount of coagulable proteins, which is stable without a preservative. Meat juices, in addition to the coagulable protein material, contain other protein bodies such as albumoses and peptones. These bodies are largely formed from the original protein bodies present in the meat juice during the process of manu- facture. They are highly nutritious and largely and readily absorbed from the alimentary canal but the amount of these bodies present in the trade products is relatively small ex- cepting in Bovinine, which is not a meat juice, particularly when the high prices are considered. A considerable proportion of the nitrogenous matter con- tained in Valentine's and Wyeth's products is present in the form of amino bodies frequently included in the general term, "extractives." These bodies may be oxidized in the body and thus supply heat in a manner similar to alcohol, but it should be remembered that there still appears to be a wide difference of opinion among various observers on this point. Some appear to be of the opinion that the amino bodies are devoid of food value in that these bodies appear in the urine prac- tically unchanged. It would, therefore, appear that the value of the amino bodies is largely of a stimulant character. The food value of meat juices, therefore, resides largely, if not solely, in the coagulable and other protein material pres- ent. Comparing the calorific value or potential energy avail- able in meat juices proper on this basis with that present in the commercial products, excluding Bovinine, it will be seen that on the average the genuine meat juices-that is, those made by pressure, direct from the meat itself as wanted-are much superior to the commercial products, notwithstanding the marked concentration in some cases. The calories given in the accompanying table do not include sugar, alcohol or any other added material of this character. wyetii's beef juice "Wyeth's Beef Juice" is not a true beef juice, but resem- bles rather a diluted meat extract. It contains much added inorganic matter, is low in coagulable proteins, and con- sidering the degree of concentration, relatively deficient in nutritive value. Some of the claims contained in the circular accompanying this preparation, in view of its composition set forth above, may be of interest: "Wyeth's Beef Juice . . . , containing two fluid ounces and representing three pounds of prime lean beef, . . ." " . . . beef extracts made 'by the Liebig process are utterly COUNCIL REPORTS 63 devoid of the valuable and nutritious albuminous constituents of meat, . . ." [Wyeth's Beef Juice] "should not be compared with ordinary beef extract, . . ." BOVININE Bovinine, advertised as a "condensed beef juice prepared by a cold process" is a mixture of alcohol, glycerin, added sodium chlorid, and apparently some form of defibrinated blood. Ac- cording to the manufacturer's literature egg albumin was used formerly but this ingredient is said to be no longer employed. It is not a meat juice in any sense of the word. Numerous misrepresentations will be found on the label and in the literature of Bovinine, of which the following are typical: "The blood of selected steers prepared by a cold process, furnish- ing a perfect food, free from insoluble elements.'' "The rapidity with which Bovinine is absorbed and assimilated in the stomach . . ." "It supplies complete nutrition to the patient." "Bovinine contains all the elements of the animal, vegetable and mineral kingdoms for the production of new blood with great rapidity. Its principal constituents have been selected with a view to furnish the largest amount of nutriment in the most con- densed form and all the resources of modern chemical analysis have been brought to bear on this important problem." A series of experiments carried out with dogs under anes- thesia, by injecting Bovinine into the stomach, the pyloric end of which was ligated, shows that Bovinine is not readily ab- sorbed and assimilated by the stomach as claimed. The amount of protein material found in the stomach at the end of one-half hour to one hour and a quarter was practically equal to the amount introduced by the Bovinine. It is also represented that Bovinine is of great service in ease of an irritable stomach. This is not borne out by ex- periment. Bovinine fed to dogs by the mouth, either alone or mixed with food, induced vomiting, which was less marked when Bovinine was given with the regular diet. An examina- tion of the urine of these animals showed a marked diminu- tion of the amount of indican, while the ethereal sulphates were enormously increased, both absolutely and relatively, when Bovinine was given. Experiments on rabbits have shown that Bovinine injected into the peritoneal cavity was invar- iably followed by large quantities of albumin in the urine, which persisted for from 24 to 48 hours. Thirty to 50 c.c. per kilo given by mouth daily caused emaciation and weakness; in some cases, irritation of the gastrointestinal canal, with death of the animal in from 7 to 12 days. 64 PROPAGANDA FOR REFORM CARNINE Carnine is a French preparation imported into the United States by Fougera & Co., of New York City. In physical ap- pearace it looks like highly concentrated food, but analysis shows that it consists of a small proportion of defibrinated blood dissolved in a mixture of syrup and glycerol, the whole agreeably flavored. It is represented as a "juice of rare meat, prepared by cold process. Each tablespoonful represents 100 gm. of raw meat, or 3% ounces." It is clear that Carnine is not a meat juice in any sense of the word. valentine's meat juice Valentine's Meat Juice resembles in physical appearance taste, odor and by chemical analysis a diluted meat extract. The nutritive value of meat .extracts is virtually nil, as is well-known by the medical profession. Notwithstanding the composition of Valentine's Meat Juice and the fact that beef extract represents little nutritive value, the manufacturer makes the following misleading representations: "The two-ounce oval bottle, adopted for the Meat Juice contains the concentrated juice of four pounds of the best beef, exclusive of fat; or the condensed essence of one and a half pints of pure liquid juice which is obtained from the flesh of beef." "The use of hot water with the Meat Juice changes its character and impairs its value." [Italics in original.-Ed.] The company must certainly be aware of the fact that its product contains little, if any, coagulable proteids. CONCLUSIONS In conclusion; neither Bovinine nor Carnine is a meat juice, the former is anything but palatable and the latter soon cloys. "Valentine's Meat Juice" and "Wyeth's Beef Juice" are virtually diluted meat extracts which are known to possess little food value. A physician depending on any of the fore- going products to supply material nourishment, in case of serious illness, is deceiving himself, starving his patients, and may be lessening their chances for recovery. If a patient recovers while using these commodities, it is certainly not due to the food value contained in them.-(From The Journal A. M. A., Nov. 20, 1909.) MIGRAININ Report of the Council on Pharmacy and Chemistry The Council having voted to rescind the acceptance of Migrainin and to omit it from New and Nonofficial Remedies (Appendix), directed publication of the report given below. W. A. Pucknek, Secretary. COUNCIL REPORTS 65 SUPPLEMENTAL REPORT ON MIGRAININ To the Council:-Koechl & Co., American agents for Mi- grainin (Meister Lucius & Bruning) asserted that this prepara- tion was a mixture of antipyrin 85 parts, caffein 9 parts and citric acid 6 parts. The experiments of F. Zernik (Apoth.-Ztg., 1906, p. 686), however, showed that Migrainin consisted of antipyrin 90.88 parts, caffein 8.4 parts and citric acid 0.45 parts. When the attention of Koechl & Co. was called to this they informed the Council, on June 20, 1907, that the formula they gave was given them direct by the manufacturers abroad and that they, Koechl & Co., did not question its accuracy. They, however, offered to "write abroad and have the manu- facturers confirm the formula as given." On July 23, 1907, Koechl & Co. wrote the secretary of the Council that the man- ufacturers had informed them that Migrainin contains 90 per cent, antipyrin and 9.1 per cent, caffein citrate. This being an acknowledgment that the former statement submitted was incorrect, the Council voted that the approval of Migrainin should be reconsidered. Examination of the product, there- fore, was taken up in the Association's laboratory and an original specimen, purchased in Chicago, was found to con- tain moisture 0.7 per cent., antipyrin. 90.93 per cent., and in- stead of caffein citrate 9.1 per cent., citric acid 0.51 per cent., caffein 8.53 per cent.1 This analysis agreed essentially with the composition of Migrainin as found by Zernik. While the discrepancies between the statement of the firm and the facts are perhaps not great, nevertheless they show that even the formula last given is incorrect, and that the statements of Koechl & Co., while no doubt made in good faith, were in this instance unreliable. In recent advertising matter issued by Koechl & Co., "phenozon-caffein citrate" is given as a synonym for Mi- grainin, one circular stating that "Migrainin is phenozon- caffein citrate," etc. In the same circular the following also 1. Caffein citrate is readily hydrolyzed by water, but in the dry form the existence of three caffiein citrate& is possible as fol- lows : (1). C8I1ioN402.C0H807 contains 50.28 per cent, caffein. (2). (C8HioN402)2C0H8Ot contains 66.91 per cent, caffein. (3). (C8H10N4O2)3C6H8O7 contains 75.18 per cent, caffein. If the "caffein citrate" in Migrainin is present as in (1) there should, according to the statement of the manufacturer, be present 4.57 per cent, caffein; if as in (2), 6.08 per cent, caffein; if as in (3), 6.84 per cent, caffein: the quantity found is 8.53 per cent. If the caffein citrate is present as in (1), the citric acid present should be 4.53 per cent.; if as in (2), 3.02 per cent., and if as in (3), 2.26 per cent.: the citric acid found equals 0.51 per cent. This shows that the most recent statement of the firm, viz., that Migrainin contains 9.1 per cent, caffein citrate, is incorrect, no mat- ter what interpretation is given to the meaning of the term caffein citrate. PROPAGANDA FOP REFORM 66 appears: "In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed." This will, no doubt, lead phy- sicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonoflicial Remedies.-(From The Journal A. M. A., Time 5, 1909.) OXYCHLORINE Report of the Council on Pharmacy and Chemistry The following report on Oxyclilorine has been submitted to the Council by the subcommittee to which it was assigned: To the Council on Pharmacy and Chemistry:-Your sub- committee submits the following report: The Oxychlorine Chemical Company, 1326 Wabash Avenue, Chicago, states in its advertising literature that: "Chemically, Oxychlorine is the tetraborate of sodium and potassium combined with oxychlorid of boron, thus: 6 (NaKB,4O7) BOC13." Analysis of Oxychlorine showed: Potassium 12.26 per cent. Sodium 8.20 per cent. Chloric acid-CLOS 25.32 per cent. Nitric acid-NOS 21.70 per cent. Boric acid anhydrid-B2O3 18.63 per cent. Water, calculated 13.29 per cent. Thus, Oxychlorine is not a definite chemical substance of the composition claimed, but instead is a mixture of alkali chlorate and nitrate with boric acid. Assuming that the chlo- rate is present as potassium chlorate and the nitrate as so- dium nitrate, the. analysis above quoted corresponds to a mix- ture approximately as follows: Potassium chlorate 37.19 Sodium nitrate 29.76 Sodium and potassium tertraborate 2.18 Boric acid 30.52 Undetermined 0.35 100.00 Your committee recommends that Oxychlorine be not ap- proved and that this report be published. The report of the subcommittee was adopted by the Council, and in accordance with the recommendation is published here- with. W. A. Puckner, Secretary. COUNCIL REPORTS 67 In commenting on the above report it is hardly necessary to call attention to the palpable untruthfulness of the furnished formula, or to its lack of correspondence with the real com- position of the preparation, to the imposing claims made by its pseudo-scientific exploiters, or to the absurdities, from a chemical standpoint, of the statements made in their litera- ture. These features are more or less common to all nostrums. The physician who prescribes or uses Oxychlorine under the impression that he is getting a definite and unique chemical compound described as tetraborate of sodium and potassium combined with oxychlorid of boron is, according to our chem- ists, getting simply a mixture of potassium chlorate, sodium nitrate (or, perhaps, sodium chlorate and potassium nitrate), and boric acid in about equal amounts. More than one-third of this mixture is potassium (or sodium) chlorate, a drug by no means harmless. In order that there may be no suspicion of unfairness to the promoters of the preparation, we quote from one of the adver- tising circulars sent out by the Oxychlorine Company: "Oxychlorine owes its recognition as a therapeutic agent to its six principal qualities : "1. It will oxygenate the blood at the seat of applica- tion, maintain nutrition and heal an uninfected solution of continuity of first intention without scar formation. "2. It will disorganize all pus and ferment-producing micro-organisms, their toxins, ferments and ptomains. "3. It will restore an inflamed mucous membrane to its normal condition, except where the membrane is sclerosed or atrophied. "4. It will destroy pathogenic micro-organisms and their toxins in the blood current. "5. It will stimulate the blood to absorb more oxygen in the lungs than it at the time carries. [We do not know what this means ; perhaps the Oxychlorine Company does.] "6. It is absolutely harmless to the tissues and will not destroy a living cell," Surely these people must have access to physiologic and chemical authorities not found in modern medical libraries, or else their esoteric reseaches into the mysteries of life must have carried them far beyond the ken of our most advanced workers along these lines. The scientific world would receive with great interest information as to how a mixture of po- potassium chlorate, sodium nitrate and boric acid oxygenates blood, maintains nutrition and causes healing without scar formation. A mixture which will destroy micro-organisms and yet will not destroy a living cell certainly shows a fine sense of selection and discrimination not heretofore expected of a combination of chemicals or of a chemical compound, 68 PROPAGANDA FOR REFORM How like the wonderful elixir of medieval times, which was to the Christian a tonic and to the heathen a poison! Here is another, claim made for this nostrum: "Two or three rectal injections of a one or two per cent, solution of Oxychlorine and ten grain doses given six to eight times per day is the best and most reliable treat- ment for typhoid fever." If eighty grains of Oxychlorine contain thirty grains of po- tassium chlorate, three rectal injections each consisting of one pint of 2 per cent, solution, would contain approximately 160 grains of potassium chlorate. Such an injection might prove decidedly dangerous, especially when used by one ignorant of its true composition. However, the physician, not the pro- moters, bears the responsibility. Oxychlorine sells at $3.50 a pound; the ingredients can be obtained for about 44 cents a pound. Perhaps the margin of profit is intended as a reward due the promoters for the pro- found physiologic discoveries announced in their reading matter.-(From The Journal A. M. A., July 6, 1909, 51f.) PANTOPON Report of the Council on Pharmacy and Chemistry A referee of the Council reported that Pantopon was not eligible for inclusion with New and Nonofficial Remedies and recommended that the reasons for its rejection be published. The Council voted to adopt this recommendation and in accord- ance with its regular procedure the facts were reported to the manufacturers before publication. The firm's reply having been received, the Council authorized publication of the report which appears below. W. A. Puckner, Secretary. Pantopon Under this name, the Hoffmann LaRoche Chemical Works submitted a pharmaceutical preparation of opium, consisting of a mixture of the hydrochlorids of the various opium alkaloids, as extracted directly from the drug, with more or less purifica- tion. The Council holds that this name does not effectively suggest that the preparation is a mixture of opium alkaloids, as is required, by the part of Rule 8 which reads: "In the case of pharmaceutical preparations or mixtures the trade name must be so framed as to indicate the most potent ingre- dients." and further explains: COUNCIL REPORTS 69 "It is particularly important that actively poisonous or habit- forming drugs be not disguised under an innocently worded title." The Council maintains that the name "Pantopon" does not sufficiently protect the public against the habit-forming and other dangers inherent in such mixtures. The manufacturers, on being informed of these objections, offered to substitute the name "Omopon." As this is open to the same objections, it could not be accepted by the Council. After much correspond- ence, the manufacturers refused to consider any other name which would more definitely suggest its composition. The Council is therefore forced to reject the product and has ordered the publication of this report. Comment: This is a case in which the rules of the Council are in conflict with the views of the manufacturers and the Council is bound in consistency to stand by its rules, which are framed to protect the public and the profession. Pantopon is not a definite chemical body, but a mixture of known sub- stances-the several alkaloids naturally occurring in opium- and the Council's rules require that such a preparation should bear a name indicative of its composition. The name "Pan- topon" although it might suggest opium to those well acquainted with Greek would not do so to all and it would be relatively easy for physicians to fall into the habit of using it indiscriminately without realizing fully the character of the preparation, and the preparation thus becomes a menace to the public. As to the merits of the preparation itself, it is remarkable what a literature has been built about a simple mixture of the opium alkaloids. The preparation is claimed to be superior to opium because it is more readily soluble. This trifling advan- tage seems to have been sufficient, however, to justify the pub- lication of a dozen or more pamphlets. But in reality, this preparation is nothing more, therapeutically, than a form of opium and, therefore, should be known to the physician as opium. The reports made of its action seem to indicate a lack of critical sifting of the evidence. Notwithstanding, both its source and the fact that experimental and clinical reports emphasize its close resemblance to opium and morphin, one author (H. Haymann, "Pantopon in der Psychiatric," Munch, med. Wchnschr., No. 43, 1910) remarks that a habit was not produced, inferring that something in the character of the preparation prevented the formation of such a habit. 70 PROPAGANDA FOR REFORM rhe one thing to be kept in mind in considering the claims made in the literature for this preparation is that it represents opium and opium only and any statements of its superiority to opium must be read in the light of the well-known tendency of writers to exaggerate the virtues of proprietary substitutes for official substances.-(From The Journal A. M. A., April 29, 1911.) PAPAYANS BELL Report of the Council on Pharmacy and Chemistry The following report of a subcommittee was submitted to, and adopted by, the Council and its publication directed. W. A. Puckner, Secretary. Papayans (Bell) made by Bell & Co., Orangeburg,' N. Y., is said to consist of the "digestive principle obtained by our own exclusive process from the fruit of Carica papaya, com- bined with willow charcoal, chemically pure sodium bicarbon- ate and aromatics." The following statement appears on the package: "For the treatment of dyspepsia, flatulence, nausea, vertigo, hyperacidity, palpitation and other symptoms of in- digestion and the vomiting of pregnancy. Peritonitis, cholera morbus, alcoholism and seasickness." "Digests every variety of food, removes every symptom of indigestion,' restores the entire digestive tract to a normal condition." The dosage is recommended as follows: "From one to three tablets before meals, or two hours after eating. In severe cases, three tab- lets dissolved in hot water and repeated as necessary." A circular which accompanies the package details the thera- peutic virtues of the preparation and contains what purports to be extracts from medical journals, in which Papayans is recommended. Examination of specimens purchased in the open market showed them to contain the following ingredients: Charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. As the product is said to contain papain, the presence of en- zymes was tested for, with the result that it was found to possess neither proteolytic nor amylolytic properties. The results of our examination are in accord with the results ob- tained by a member of the Council, who examined the product independently, and who writes: "We have made some extended tests with Papayans Bell, and find that the tablets consist essentially of sodium bicar- bonate and charcoal, with a little flavoring matter. We find no digesting power for starch or egg albumin. At any rate, no appreciable change follows in the albumin in three hours, and no conversion to sugar in the same time, or change of starch to a point where the iodin reaction is weakened. The product seems to be practically inert." COUNCIL REPORTS 71 It is recommended that Papayans Bell be refused recogni- tion, and that publication of this report be authorized. Comment: It will be remembered that two other products of Messrs. Bell & Company have been discussed in this depart- ment: Salacetin (Bell)1 and Sal-Codeia (Bell)2. Salacetin was examined with several "synthetics" which all turned out to be mere acetanilid mixtures. Salacetin, advertised as "a combination, with heat, of Salicylic and Glacial Acetic Acids and Phenylamine" when examined "was found to be a mixture and to contain the following ingredients approximately in the proportion given: Acetanilid, 43; sodium bicarbonate, 21; and ammonium carbonate, 20." Sal-Codeia (Salacetin-Codein) therefore, would be the same with codein added. Papayans (Bell) seems to be consistently fulfilling the life- history of the average nostrum. Made of well-known drugs and invested by its manufacturers-or exploiters-with vir- tues absurdly disproportionate to the known properties of the alleged constituents of the nostrum, the preparation was introduced to the world via the medical profession. With the help of thoughtless physicians, aided by a skillful and aggressive advertising campaign and augmented by the "free sample" device, the business grew and prospered. The bottles with the name and address of the company blown in the glass and with the varied therapeutic indications for the nostrum printed both on the label and on a circular in which the bot- tle is wrapped, have carried the manufacturer's message to the drug-taking public. Apropos of this point, the recent "literature" contains what purports to be endorsements of the nostrum by medical jour- nals. Thus there is quoted from the New York Medical Jour- nal, Jan. 2, 1909, in part, the following recommendation: . we venture to suggest to our readers who have not tried this remedy that they prescribe one original sealed pack- age of Papayans (Bell) and that they carefully note the re- sults from its use." [Italics ours.-Ed.] Having seen an "original sealed package" we believe that we can predict the "results from its use." On any patient not mentally unbal- anced, the result would be that the next dose of Papayans (Bell) he thought that he needed would be purchased from the druggist direct. That such results are not hypothetical is evidenced by the statements of the exploiters of Papayans (Bell) that "the 1. See page 239. 2. See page 241. 72 PROPAGANDA FOR REFORM annual sale now exceeds four hundred million tablets." As- suming this statement to be true, it would be necessary for every physician in the United States to prescribe over three thousand of these tablets every year-if they reached patients only through the physician! The company's own figures indicate that the time is about ripe to take care of this vast army of self-drugging laymen and recent circular letters seem to recognize it. The physician is notified that druggists are now furnished with Papayans (Bell) "in sealed packages of thirty and one hundred tablets." The medical man is told that the firm has "not forgotten the days when physicians' orders made our success possible" and it says it is "sincerely grateful to the doctors who gave us orders in the days when we were struggling for recognition?' This tacit admission of the value of the physician as an unpaid agent for nostrum houses should be given thought by those physicians who prescribe such preparations. While, so far as we know, Bell & Co. have not yet adver- tised in the daily press, they are not averse to furnishing the laity with samples when requested. An Ohio physician sent us the following letter received by a young woman who had written asking for samples: Miss X Y , Z . Dear Madam : As requested, we are mailing you sample of our Papayans (Bell) for Indigestion. If a sufferer from Indigestion, we want you to give it a thor- ough trial as directed and note remarkable results that we believe you will get from its use. Kindly write us if you are unable to obtain it from your local druggist, as it is stocked by nearly every good drugstore in the United States. Yours truly, Bell & Co. Evidently Bell & Co., while admitting that their financial success is largely due to the kindly, though misguided, efforts of physicians, are not going to let a little thing like loyalty to the medical profession interfere with a possible sale of their tablets. THE L. D. JOHNS COMPANY A discussion of the methods of Bell & Company would not be complete without reference to a concern which seems to be closely connected with it: the L. D. Johns Company, whose "only product" is a sugar-coated laxative tablet. Regarding the "sugar coated" tablet, a visitor at the place of business COUNCIL REPORTS 73 of Bell & Company and the L. D. Johns Company, wrote: "These companies apparently are not in possession of any tablet coating machines and in questioning on this point stated that some of their tablets were sent out to be coated." There is a sameness regarding the claims for the laxative tab- lets of the two companies that might lead one to suspect that the same individual prepared both. For instance: Cascarans (Bell) "Taken as directed, it per- manently removes the great majority of cases of habitual constipation." " . . . a harmless vege- table preparation." " for the removal of pimples, yellowness and greasiness of the skin . . ." " '. . . one tablet at night, one night and morning, or, in severe cases, one three times a day, gradually decreas- ing the frequency of the dose as improvement permits." Dr. John's Tablets "Taken as directed . . . permanently remove the great majority of cases of habitual constipation, torpid liver and sick headache." "A harmless vegetable rem- edy." " . . . removes pimples, blotches, sallowness and greasi- ness of the skin ..." "One at night, one night and morning, or, in severe cases, one three times a day. Grad- ually decrease the frequency of the dose as improvement per- mits." According to a leaflet sent out with samples by the L. D. Johns Company, the company is capitalized for $500,000, divided into 50,000 shares at $10.00 each; these shares are sold to those physicians who will agree "to prescribe the tablets at every suitable opportunity, to introduce them to other physicians" and "to pro- mote their sale in every ethical way"! If the list of phy- sicians' names and addresses which the company sends out as comprising the eastern stockholders is to be relied on, it would seem that many medical men are promoting their sale. In prescribing it is, of course, "necessary to specify 'Dr. Johns' Tablets No. XXX (Original bottle).'" As the name is on the bottle, it is not unbelievable that, as the company says in its prospectus, because of "our method of advertising, a large and very profitable business is being created." That the L. D. Johns Company expects to profit by the self-drugging which this method of prescribing fosters is evident: ''Physicians not stockholders In this company suffer from the continual refilling of their prescriptions and from the recommenda- tion of the preparation prescribed by patients to others. [Italics ours.-Ed.] Our stockholders benefit by the refilling of their Dre- scriptions and by these recommendations." 74 PROPAGANDA FOR REFORM Put baldly the case amounts to this: Physicians who pre- scribe "Dr. Johns' Tablets" not only are likely to foster self- drugging, but they will reap dividends therefrom. Truly a nice business to be in! While Bell & Company and the L. D. Johns Company are said to be entirely distinct, they are to be found at the same address at Orangeburg, New York, and as will be seen, the officers of the two companies are more or less related. BELL & CO. L. D. JOHNS CO. President - - - John L. Dodge - - - President Secretary - - - Geo. C. Tennant - - Vice-President Vice-President - - Chas. B. Smith - - - Sec'y and Treasurer EXPLOITING THE PROFESSION Nostrum promoters have two simple ways of "working" the medical profession. The first-and the more profitable- is, by lavish distribution of free samples, to get physicians to prescribe the blown-in-the-glass "original package" with the inevitable result of large sales direct to the laity. By the second method, which is merely a modification of the first, the physician furnishes the capital for floating the nostrum and then takes his share of the resulting profits. There may not be quite as much money in the second method for the promo- ter, but then the risks are correspondingly less. If the firm fails, the stockholders are the losers; the promoter is not necessarily "out" anything. From a commercial standpoint, a combination of the two methods is, of course, ideal.-(From The Journal A. M. A., Aug. I}, 1900.) PASSIFLORA AND DANIEL'S CONCENTRATED TINC- TURE OF PASSIFLORA Report of the Council on Pharmacy and Chemistry The Council has voted that the drug passiflora (passion flower) be not accepted for New and Nonofficial Remedies, and has recommended that the following article be published in The Journal. It is considered important to call attention, not only to the lack of reliable evidence of the therapeutic value of passiflora, but also to the absurdity of the claims which are made for Daniel's concentrated tincture of passiflora, a preparation which has been already refused recognition. W. A. Puckner, Secretary. COORCIL REPORTS 75 Passiflora Although passiflora was introduced into medicine nearly seventy years ago, the literature concerning it is not very extensive; it is not mentioned in the standard works on pharmacology and its chemistry seems never to have been worked out. There appears, also, to be no record of experi- mental investigations of the drug with reference to its phar- macologic action, except an article by I. Ott,1 who used "Daniel's concentrated tincture." Ott claimed that it les- sened the reflex irritability of the cord and paralyzed motion by acting on the motor centers in the cord, and that it increased the rate of respiration. He also stated that because of its action on the vasomotor centers it reduced the fre- quency of the heart-beat and lowered arterial tension, but these effects were only temporary. On the clinical side the reports are not numerous and such as have been made do not appear to be based on very exten- sive trials nor on conditions of observation that would entitle them to more than slight consideration. S. D. Bullington2 reports good results, but no cure, in one case of epilepsy, and improvement in a case of insomnia. W. J. Stapleton3 rec- ommends it in the form of a concentrated tincture (not the one advertised so extensively), and states that he has used it with great success in insomnia, hysteria, neurasthenia, neu- ralgia, nervous and physical prostration, and in alcoholism. In his opinion its action is most apparent in cases of nervous- ness due to causes other than pain. S. Harnsberger4 reports two cases in which partial blindness followed the taking of potassium bromid and passion flower. Extravagant and inconsistent claims are made for Daniel's concentrated tincture of passiflora in the advertising litera- ture, where it is recommended for such a wide range of dis- eases as asthma, typhoid fever, convulsions and paralysis. None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include this drug in the list of nonoffieial remedies.-(From The ■Journal A. M. A., March 19, 1910.) 1. Med. Bull., 1898, xx, 457-464. 2. Nashville Jour. Med. and Surg.. 1897, Ixxxi, 107-109. 3. Detroit Med. Jour., 1904-5, Iv, 17. 4. Virginia Med. Semimonthly, 1898-9, iii, 392. 76 PROPAGANDA FOR REFORM PEPSIN AND PANCREATIN Report of the Council on Pharmacy and Chemistry In this report of the Council on Pharmacy and Chemistry attention was called to the incompatibility of pancreatin and pepsin. There are a large number of preparations claiming to combine the virtues of these two substances as digestants which are absolutely worthless for this purpose. The two substances mutually destroy each other and when diastase is also present with pepsin they also mutually destroy each other. The subcommittee reporting recommended: 1. That the Council on Pharmacy and Chemistry refuse to approve liquid preparations that are claimed to contain both pepsin and pancreatin. 2. That the medical profession through The Journal of the American Medical Association be advised of the fallacy of employing such combinations. 3. That the attention of manufacturers be called to the worthlessness of such incompatible liquid preparations of pep- sin and pancreatin, and that they be' urged to cease offering such products to the profession. 4. That, since the National Formulary has recognized a preparation of this Kind under the title "Elixir Digestivum Compositum," the American Pharmaceutical Association be requested to instruct its committee on the National Formulary to omit this preparation from the next edition. A partial list of preparations on the market is appended, with quotations from text books showing the incompatibility. -(Abstracted from The Journal A. M. A., Feb. 2, 1907, 1(31/.) PHENOL SODIQUE (Hance Bros. & White) Report of Examination by Council on Pharmacy and Chemistry and Comments An examination of this article by a subcommittee of the Council on Pharmacy and Chemistry revealed unscrupulous claims which are a positive menace to public health. In view of this the Council has directed the publication of the follow- ing comments. W. A. Puckneb, Secretary. COMMENTS Phenol Sodique was not submitted to the Council by the manufacturers, but was taken up because it is advertised to both physicians and the public. Some advertisements state: "Phenol Sodique was the standard antiseptic thirty years ago. It's the same to-day." If this were true, it would be high time COUNCIL REPORTS 77 to call a halt; for the unscrupulous claims made for this nos- trum, and the effrontery with which they are pushed, are only rivaled by those of the most shameless "patent medicines." The firm of Hance Bros. & White poses as a reputable pharmaceutical manufacturing house, but how it can recon- cile this position with the methods of exploiting this product passes all understanding. In the original package of Phenol Sodique (the latest was purchased on June 20, 1907), there are little booklets and a folder describing the marvelous prop- erties of the nostrum. The booklets do not refer to Phenol Sodique, but they are very instructive. They are entitled: "Dyspepsia," "Worm News," and "Catarrh," advertising "Dyspepsia Stop"-some form of dyspepsia tablets, a remedy for round worms, and "Catarrh Stop," apparently some mild antiseptic tablets. These booklets are addressed frankly to the laity, although recourse to a physician is, generously, advised if the patient does not respond to treatment! The folly of prescribing "original packages" which contain popular literature has been so often emphasized that further comment seems superfluous. The following from "Catarrh," however, throws an interesting sidelight on the scientific status of Hance Bros. & White: "Catarrh is due to a minute insect in the inner lin- ing membrane of the nose. This insect multiplies rap- idly, and, unless checked and destroyed, will produce the worst results." To return, however, to Phenol Sodique: The folder is also evidently intended for the lay public rather than for physi- cians; at least, if we are to credit Hance Bros. & White with any intelligence whatsoever. It is headed: "Montyon Prize of Encouragement, Awarded by the Institute of France, 1861." This is rather ancient, but what follows indicates that a little restraint would have been better than encouragement. The circular is a compact treatise on self-medication-apparently all that is necessary to retain or regain health is' the use of Phenol Sodique, externally and internally. The following con- ditions are among those specifically named as amenable to this remedy: Small-pox, measles, scarlatina, erysipelas, puerperal fever, typhoid fever, cholera, diarrhea, cramps, burns and scalds, bites, cuts and wounds, excoriations, chilblains, chaps, sore. throat, scratches, catarrh, tetter, sunburn, swollen veins, ulcers, hemorrhages, bruises, piles, gangrene, carbuncle, itching, insect stings, ivy poison, cold in the head, bunions, inflamed 78 PROPAGANDA FOR REFORM eyes, eczema, ringworm, rheumatism, pains, toothache, seat worms, etc.-besides numerous diseases of animals. No antiseptic, whatever its composition, could by any pos- sibility accomplish anything like what is claimed for Phenol Sodique, so that the composition of the article is really of little importance. This is evidently appreciated by the manu- facturers, for they have kept the composition a profound secret, except in so far as it is implied in the name. An inquiry addressed to Hance Bros. & White, under date of April 27, 1907, six months ago, has remained unanswered. The Council, therefore, directed an analysis of Phenol Sodique. This was carried out at the chemical laboratory of the American Med- ical Association, and a check analysis was made by an inde- pendent firm of chemists. This shows that Phenol-Sodique contains something like 0.5 or 0.66 per cent, of phenols, dissolved in about 0.75 per cent, of sodium hydroxid. In other words, it appears to be essen- tially a very dilute alkaline solution of some impure coal-tar product, presumably a crude carbolic acid. The analysis could not profitably be carried further, because the amount of the antiseptic agent is so very small. The consideration of this analysis, in connection with the claims made for Phenol-Sodique, leaves little doubt as to one reason for the secrecy concerning its composition; although no educated physician could be deceived into believing for a moment that Phenol-Sodique could fulfill the promises of its promoters, even if it were "the best antiseptic, hemostatic and disinfectant on the market," as the manufacturers say in their advertisements. From its composition, it can only have the very moderate and ordinary antiseptic qualities of a dilute phenol or cresol solution, modified only to a very slight extent by the free alkali. According to the manufacturers, however, "Phenol- Sodique is a wonderful preparation." Just how wonderful appears from these extracts from the dissertations in the pamphlet which is enclosed in the package. Note particularly the matter which we have put in capitals: Catarrh, Old Colds, etc.: Drink every morning and evening a glass of water containing ten to thirty drops of Phenol- Sodique. . . . "SMALLPOX: TO PREVENT ATTACK take internally three or four times a day, fifteen or twenty drops of Phenol- Sodique in one tablespoonful of sugar and water. . . . COUNCIL REPORTS 79 "Measles, Scarlatina and Erysipelas: Same treatment as for Smallpox. "TYPHOID FEVER: TO PREVENT ATTACK take inter- nally three or four tim'es a day, fifteen or twenty drops of Phenol-Sodique. "CHOLERA: TO PREVENT spread sawdust or sand wet with Phenol-Sodique, in apartments. "THE VERY BEST PRECAUTION is to drink, morning and evening, a glass of water containing from fifteen to thirty drops of Phenol-Sodique. . . " . . . Premonitory Diarrhea: . . . Drink a teaspoon- ful of Phenol-Sodique diluted in an ounce of water. . . ." This is the kind of therapeutics and prophylaxis taught to the medical profession by their self-appointed instructors, the proprietors! But this matter has a serious as well as a ludicrous side: What is the proper epithet to apply to those who, knowingly and intentionally, impress on the ignorant lay public that one can with impunity expose himself to small-pox, cholera, typhoid or scarlet fever, or measles, by taking a few drops of very dilute carbolic acid, or by sprinkling a little on sawdust? What must be the consequences to those who trust in these assurances? And what should be the lawful penalty for those whose blunted moral instincts permit them wilfully to endan- ger the lives of others for a little financial gain? It would be interesting to know the real opinion of the responsible mem- bers of the firm of Hance Bros. & White on these questions. The Montyon Prize was awarded by the French Institute in 1861-forty-six years ago-how many victims a year?-(From The Journal A. M. A., Nov. 9, 1901, 1611.) SUCCUS ALTERANS Report of the Council on Pharmacy and Chemistry The following report was adopted by the Council: It is believed that unwaiTanted and exaggerated therapeutic claims are made for Succus Alterans by its manufacturers, Eli Lilly & Co., Indianapolis. In view of the disastrous re- sults which may follow, if, from the statements made, physi- cians should be led to rely on the product as a treatment for syphilis, it is recommended that Succus Alterans be refused recognition and that this fact be published with comments. W. A. Puckner, Secretary. 80 PROPAGANDA FOR REFORM Comment: Succus alterans is a preparation which has been put on the market for some years by Eli Lilly & Co., as a rem- edy for syphilis. The serious character of this disease and especially the deplorable results that ensue from its improper or insufficient treatment, should make a firm hesitate to ad- vise any treatment for it which experience has not demon- strated to be at least as efficacious as that which is generally accepted and well proved. Succus alterans is the result of a combination of circumstances; no one person is responsible for it. It was probably the natural desire for a remedy free from the occasional injurious results of mercury that led Dr. J. Marion Sims to advocate the use of a collection of in- digenous American plant drugs, sarsaparilla, stillingia, xan- thoxylum, etc., which had a local reputation for the cure of syphilis. These drugs are supposed to be inert when the dried plants were used, and this gave an opportunity for the devel- opment of a nostrum. The ingredients are well known, but as their virtues are supposed to be lost in drying, the physi- cian can not have his druggist compound them, but must, per- force, prescribe the proprietary combination. Those who consented to experiment with the new remedy soon found that the claims to curative properties were un- founded, but the strong commercial interests backing it have prolonged its life to the present time. Authorities on syphilis either say nothing about the preparation or mention it merely to condemn; but the proprietors of the nostrum continue to assert that it is not only practically a specific in syphilis, but now recommend it for various derangements of the blood and all sorts of skin diseases. This being the ease, what shall the wise physician do? Shall he blindly follow an authority of a past generation or shall he recognize that the claims of an interested manufac- turer ought not to weigh against the consensus of his present- day confreres who have given the treatment of syphilis their special attention? The exploitation of such a preparation is deserving of strong censure. By such methods the firm places itself on the same plane as those nostrum venders, who ad- vertise certain antiseptic sprays and gargles as cures for epi- demic meningitis and diphtheria and thereoy deprive credulous victims of the curative antitoxin treatment. Succus alterans is not a new remedy on trial for its possibilities of im- provement in therapeutics; it is an old mixture which has been tried and found wanting.-(From The Journal A. M. A., June 26, 1909.) COUNCIL REPORTS 81 QUININ ARSENATE Report of the Council on Pharmacy and Chemistry The advisability of admitting quinin arsenate as a non-pro- prietary article to New and Nonofficial Remedies was taken up for consideration by the Council and the product was referred to a committee on chemistry. This committee recommended that the opinion of the staff of clinical consultants should be obtained relative to the value of this product. This was done and on the staff's recommendation the drug was refused recog- nition and the Council ordered the following statements to be published. W. A. Puckner, Secretary. Quinin arsenate is the secondary quinin salt of arsenic acid. It contains 8 per cent, of elementary arsenic and 69 per cent, of anhydrous quinin. 0.1 gm. (1% grains) would be equiva- lent to approximately .092 gm. (1 9/20 grains) of quinin sul- phate and to 0.032 gm. (% grain) of sodium arsenate (five times the official dose). It is thus seen that the proportions of the two chief ingredients in the salt are such that an efficient dose of quinin cannot be given in this form without introduc- ing a dangerous amount of arsenic. As it does not appear that this preparation possesses any properties that might not be found in a mixture of quinin salts and various preparations of arsenic, and as it has no advantage over other forms of arsenic now available there is no reason for including it among unofficial non-proprietary remedies. Attempts to sub- stitute it for other quinin salts would be likely to lead to overdosing with arsenic.-(From The Journal A. M. A., July 16, 1910.) STRYCHNIN ARSENATE Report of the Council on Pharmacy and Chemistry The Council, after considering the advisability of admitting to New and Nonofficial Remedies the unofficial, non-proprie- tary preparation, strychnin arsenate, decided not to admit it, and authorized publication of the following report. W. A. Puckner, Secretary. Strychnin arsenate is a compound of the alkaloid strychnin with arsenic acid, containing between 68 and 70 per cent, of anhydrous strychnin. It is a white, crystalline powder of small, colorless or faintly yellowish, transparent or slightly opaque prisms, or in white acicular crystals, odorless but extremely bitter. It is slowly soluble in about 20 parts of 82 PROPAGANDA FOR REFORM water at 25 C., more readily soluble in hot water, slightly soluble in alcohol, insoluble in chloroform or ether. After considering the properties of this substance the Council voted not to accept it for N. N. R., as there is no sufficient reason for combining two powerful remedies in such form. As a chemical combination there appears to be no objection to it, as the compound is sufficiently definite, but the readiness with which the salt separates into its constitu- ents, strychnin and arsenic acid, indicates that it can present no advantages over a mixture of its components so far as pharmacologic action and therapeutic use are concerned. On the other hand, it is both unscientific and irrational to pre- scribe two such energetic remedies having quite different indi- cations under such a fixed form that the efficient dose of one may involve an unsuitable and perhaps dangerous dose of the other. If a dose of strychnin arsenate equivalent to 0.002 gm. (1/32 grain) of strychnin sulphate is given, the patient would receive about 0.00063 gm. (1/100 grain) of arsenic acid, which is about one-fifth the official dose. On the other hand, strych- nin arsenate cannot be used to bring out the therapeutic effects of arsenic in cases in which it is necessary to push the latter remedy, because this would necessitate the giving of dangerous doses of strychnin. A much more appropriate and scientific procedure would be to prescribe the medicines separately or in an extemporaneous pill or solution in which the proportions of the two ingredients could be changed • from time to time according to the varying indications in the particular case.- (From The Journal A. M. A., Sept. 24, 1910.) SULPHO-LYTHIN Report of the Council on Pharmacy and Chemistry Sulpho-Lythin is sold by the Laine Chemical Company, New York. In the literature sent to physicians it is said: "This product, the sulpho-phosphite of sodium and lithium (non-effervescent), is entirely new and is unique in its action." Chemical analysis of a specimen of Sulpho-Lythin pur- chased in the open market indicated its composition to be: Sodium sulphate, anhydrous 10.51 Disodium hydrogen phosphate, anhydrous 56.67 Sodium thiosulphate, anhydrous 20.78 Sodium chlorid 5.98 Lithium, as citrate 3.12 Sulphur, tree 0.16 Moisture 1.53 Loss 1.25 COUNCIL REPO UTS 83 The examination, therefore, shows that Sulpho-Lythin is a mixture consisting mainly of sodium sulphate and sodium phosphate and sodium thiosulphate. The statement that it is a "sulpho-phosphite of sodium and lithium," therefore, is not correct, and a statement that "it is entirely new and unique in its action" appears unwarranted and misleading. It is, therefore, recommended that the preparation be refused recog- nition. It is also recommended that an article be prepared for publication calling attention to the exaggerated claims made for Sulpho-Lythin. The recommendations of the subcommittee were adopted by the Council and in accordance, therewith the report is pub- lished, with comments, substantially as follows: The formula means that it is a solution of well-known salts, some of them under partially disguised names. Every one knows what Glauber's salts are good for. Disodium hydrogen phosphate is ordinary common sodium phosphate. Sodium thiosulphate is familiar as sodium hyposulphite, the "hypo" of the pho- tographers. Every one knows, of course, that sodium chlorid is common salt. Examination and analysis of various speci- mens of this product demonstrated that its composition is not always the same. As an indication of the ignorance of the promoters of this nostrum it is interesting to note that the label on one of the bottles purchased states that it is a "sul- phophosphate" instead of a sulphophosphite. Extravagant claims are made for this simple mixture of laxative salts, and these with the methods of using it are printed on the labels, and while it is claimed to be only advertised to the profes- sion, the physician is repeatedly advised in the advertisements to "order always an original (six ounce) bottle to prevent substitution." The natural result of this would be, of course, to put the patient in the way of prescribing it for himself and to spread the advertisement of the drug among the pub- lic. Difficulty has been experienced in finding out who the promoters of this nostrum are and the correspondence in regard to it is published. They seem to prefer to be known by their corporate title of Laine Chemical Company only. It is a sample of many other so-called ethical proprietary drugs, most of which are simple mixtures of well-known drugs which physicians are using every day and which require no skill in their compounding. Their proprietors not only presume to sell and advertise medicines but also to tell the physicians how to treat their patients.-(Abstracted from The Journal A. M. A., Dec. 8, 1906.) 84 PROPAGANDA FOR REFORM TYREE'S ANTISEPTIC POWDER Report of the Council on Pharmacy and Chemistry with Comments Tyree's antiseptic powder was assigned for examination to a subcommittee of the Council, which made the following report: To the Council on Pharmacy and Chemistry:-Your sub- committee, to whom was assigned Tyree's Pulv. Antiseptic Comp., marketed by J. S. Tyree, Washington, D. C., reports as follows: The label on the package states: "This preparation is a scientific combination of borate of sodium, alumen, car- bolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder," etc. The statement that the powder contains the crystalline principles of thyme, eucalyptus, gaultheria and mentha is vague and misleading, since the chief medical constituents of eucalyptus and gaultheria are liquids, but it tends to convey the impression that the powder contains the essential con- stituents of these drugs, namely, thymol, oil of eucalyptus or eucalyptol, oil of wintergreen, or methyl salicylate, and men- thol. The literature supplied to physicians claims its composition to be: "Parts, sod. bor., 50; alumien, 50; ac. carbol., 5; glycerin, 5; the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5, and mentha, 5." The composition, therefore, might be expressed as follows: Sodium borate (borax) 50 parts, or 38.46 per cent. Alum 50 parts, or 38.46 per cent. Phenol (carbolic acid) 5 parts, or 3.85 per cent. Glycerin 5 parts, or 3.85 per cent. Thymol 5 parts, or 3.85 per cent. Oil of eucalyptus or eu- calyptol 5 parts, or 3.85 per cent. Oil of gaultheria (or methyl salicylate) 5 parts, or 3.85 per cent. Menthol 5 parts, or 3.85 per cent. Analysis of specimens purchased from different sources in the open market were made under our direction. The reports of the chemists show that Tyree's antiseptic powder contains no borax, or mere traces only, and that it contains no alum, or mere traces only. Instead, the analyses show that boric acid and zinc sulphate are the essential constituents. The amounts of carbolic acid, thymol, menthol, etc., contained in the powder, if present, were far below the quantities indicated by the formula. The presence of glycerin could not be demonstrated, and, if present, the amount must be very small. COUNCIL REPORTS 85 One chemist reports: The result of analysis shows that different samples differ slightly in composition, but that the following indicates the average composition of the product: Per cent. Zine sulphate, anhydrous 15.56 Boric acid 81.26 Volatile matter at 100° C. for four hours 0.45 The undetermined portion consists of salicylic acid, carbolic acid, menthol and eucalyptol; possibly other antiseptic agents may be present in very minute quantities. From the above findings we conclude that Tyree's antiseptic powder is a mixture of boric acid and dried zinc sulphate and antiseptic bodies, such as menthol, salicylic acid and carbolic acid, eucalyptol, etc. From this it can be readily seen that the label which is supposed to set forth the composition of Tyree's antiseptic powder is not in accord with the facts. The powder does not contain either borate of sodium or alum, and the presence of glycerin could not be established. The antiseptic agents, exclusive of the boric acid, are present only in small amounts. The report of another analysis concludes as follows: It evidently contains less than the amount stated of the principles of thyme, eucalyptus, wintergreen and mint. It also contains a very small amount indeed of carbolic acid, much less than that stated. We have been unable to identify certainly the presence of glycerin, and it is doubtful if it be present. From the result of the analysis we feel confident that the preparation is to all intents and purposes a mixture of boric acid and sulphate of zinc. The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor. In view of the fact that J. S. Tyree has given wide publicity to a formula which the preceding report has shown to be a deliberate misrepresentation of facts, it is recommended that the article be refused recognition by the Council on Pharmacy and Chemistry, and that this report be published in The Journal of the American Medical Association. The recommendation of the subcommittee was adopted by the Council in accordance with which the report is published. W. A. Puckner, Secretary. Mr. Tyree, in a letter, says that it has been his intention to inform the medical profession of his reasons for changing the formula of Tyree's Antiseptic Powder from an alum and borax base to a boracic and zinc base. This change he says was made at the suggestion of prominent physicians connected 86 PROPAGANDA FOR REFORM with hospital clinics on nose and throat, venereal and other conditions, and that he has had in contemplation the omission from the label of the various conditions to which the prepara- tion is applicable. Apropos of Mr. Tyree's claim of having (it would appear recently) changed the composition of his preparation and intending to publish the fact, there was obtained from a Chicago druggist a sample which had been in his store at least since July, 1902, none having been bought since. This particular powder was analyzed by a chemist who found the composition practically the same as that given in the Council's report. Hence it would appear that Tyree's powder has been the same for at least four years and ten months. In a note it is remarked that the national Food and Drugs Act went into operation in January, 1907. One of its provisions is that the label must not lie. Instead of repeating the old formula the new label of Tyree's antiseptic powder contains nothing about the composition. The question is asked, why is it omitted?-(Abstracted from The Journal A. M. A., Oct. 20, 1906, and May 18, 1901.) UNICORN ROOT, WILD YAM AND WILD INDIGO Report of the Council on Pharmacy and Chemistry The Council has voted that recognition be refused to the fol- lowing: Unicorn Root (Aletris farinosa), Wild Yam (Dios- corea villosa), and Wild Indigo (Baptisia tinctoria) and has authorized the publication of the following statements. W. A. Puckner, Secretary. Unicorn Root-Aletris Farinosa Unicorn Root (Aletris farinosa) contains a bitter principle and starch. Remarkable powers as a uterine tonic have been ascribed to it but have not been realized by reliable observers, the drug being practically valuless in these conditions. It enters into the composition of a number of nostrums. As a bitter it is superfluous and it should not be included among non-official drugs. Wild Yam-Dioscorea Villosa Wild Yam (Dioscorea villosa) has been little used in med- icine. It contains a saponin and an acrid resin, and is said to possess expectorant, diaphoretic and-in large doses-emetic properties. It has been recommended as a remedy in biliary colic and in muscular rheumatism. Its value in such condi- COUNCIL REPORTS 87 tions has not been verified to an extent entitling it to con- sideration as a useful remedy. Wild Indigo-Baptisia Tinctoria Wild Indigo {Baptisia tinctoria) has been in use-chiefly by the eclectics-for about three-quarters of a century, but there is no satisfactory evidence that it has any therapeutic value. The following text-books on pharmacology do not even men- tion wild indigo: Cushny, Brunton, Dixon, Binz, Sollmann. It is not official in the United States or other leading pharmaco- peias. A preparation of wild indigo is advertised with extravagant claims for its therapeutic action, but these claims are not supported by any substantial evidence. Other virtues ascribed to wild indigo are its properties as a cardiac and hepatic stim- ulant and its value in sepsis, particularly in typhoid fever. It actually has emetic and cathartic properties, but even these are inferior to those possessed by many other drugs. It is very evident that a drug possessing the extraordinary merits that have been claimed for wild indigo would not have remained unnoticed by the leading authorities on pharmacol- ogy and therapeutics, especially after its prolonged use in medicine. Owing, therefore, to the lack of substantial evi- dence of its usefulness, baptisia is not considered as of suffi- cient importance to warrant its inclusion in the list of non- official drugs. It is probably entirely superfluous.-(From The Journal A. M. A., Jan. 22, 1910.) THIALION Report of the Council on Pharmacy and Chemistry The following report was submitted to the Council by a sub- committee which examined Thialion (Vass Chemical Com- pany) : To the Council on Pharmacy and Chemistry:-We beg leave to report on Thialion as follows: Thialion is sold by the Vass Chemical Co., Danbury, Conn. In the literature supplied to physicians and in the advertise- ments in medical journals, Thialion is stated to be "a laxative salt of lithia" with the chemical formula "3Li.,O.NaO.SO3.7HO." Sodio-trilithic anhydrosulphate" is given as a synonym. An elaborate graphic or structural formula is also given. According to analyses, this preparation is a mixture consist- ing chiefly of sodium sulphate and sodium citrate with very small amounts of lithium, the average of several estimations indicating the following composition: 88 PROPAGANDA FOR REFORM Sodium citrate 58.6 Sodium sulphate, anhydrous 26.6 Sodium chlorid 3.3 Lithium citrate, anhydrous 1.8 Water 9.7 Thus, the advertising literature is a deliberate misrepresen- tation of the facts. It is, therefore, recommended that the preparation be refused recognition, and that this report be published. The recommendations of the subcommittee were adopted by the Council and in accordance therewith the above report is published. W. A. Puckner, Secretary. In publishing the above report, the Council is presenting to the medical profession another object lesson, and one that illustrates how easily our profession is being humbugged. There are several things that we may learn from the report on this nostrum, but at this time we will take up only one phase of the lesson. Many of the scientific chemical com- pounds and derivatives given us by the German chemists have been distinct advancements and have proved to be valuable ad- ditions to our therapeutic agents; further, they were received with so much favor by physicians that they have been profit- able for those who made them. It is not strange, therefore, that imitators should appear. One of the first was our old friend, Antikamnia (which was introduced as a "new synthet- ical" compound). This was followed by Ammonol, Phenalgin, Salacetin, and a host of others having acetanilid as their prin- cipal ingredient. But there are hundreds of other so-called "new chemical" compounds among the "ethical" proprietaries on the market aside from the acetanilid mixtures. These wonderful com- pounds, by the mysterious union of their ingredients, possess therapeutic properties different from, or more powerful for good than the drugs from which they are made. At least, this is what we are told, and this is what many believe or they would not sell so well. There is another factor worth noticing connected with this subject: When to the claim that the mixture is a "chemical compound" is added a complex chemical formula, it prevents the impertinent question, "What is it?" or isn't the "formula" there, and is not the information given without the asking? Most of us have been so overcome by the display of the chem- ical knowledge of the nostrum maker that we have been afraid to expose our ignorance by asking for information or explana- COUNCIL REPORTS 89 tion. And thus the promoter avoids perplexing questions, which, if answered truthfully, would spell bankruptcy. Chemical Formula: 3F12O. NaO, SO3. 7HO {Sodio-trihthtc anhydrosulphate). Graphic Formula: This picturesque "graphic formula" for Thialion appears with many of the advertisements. To most of us it looks formidable, wonderfully and deeply scientific and non-understandable; to a chemist it looks absurd. To a chemist the formula of Thialion furnished by the Vass Chemical Company signifies nothing. To a physician who pos- sesses but little knowledge of chemistry, it will seem impres- sive, and he may absorb the idea that it stands for a prepa- ration that is the result of exhaustive scientific research. To the chemist, this formula will appear as a jumble of symbols and numbers that mean nothing. It is not worth while to call attention to the simplicity of this simple mixture of ordinary salts, for it is too self-evident. As to the remarkable therapeutic qualities of Thialion, the reader is referred to that ably edited "scientific" periodical, the Uric Acid Monthly, and to the mass of "literature" relat- ing to this wonderful remedy. While there is a ridiculous side to this business, there is also a serious one. Those who have been making money out of us undoubtedly laugh in their sleeves at our gullibility, but to us as members of a presumably learned and intelligent pro- fession, it is not a laughing matter. The whole nostrum busi- ness is a shame and a disgrace.-(Modified from The Journal A. M. A., Nov. 3, 1906.) VIN MARIANI Report of the Council on Pharmacy and Chemistry Samples of Vin Mariani and of the literature distributed by the manufacturers were examined. It appears that the beverage or medicine known as "Vin Mariani" is a preparation of red wine, apparently imported from Bordeaux, and forti- 90 PHOPAGANDA FOR REFORM fled, in this country, by an alcoholic preparation of coca leaves or other parts of the coca plant. The committee con- sidered first, the character of the red wine as imported. A sample received from the port of New York, March 10, 1905, from Henry Clausel & Co., Bordeaux, and consigned to Mariani & Co., on analysis was found to have the following composi- tion : Specific gravity 0.9959 Alcohol by volume per cent. 10.00 Extract per cent. 2.279 Volatile acids per cent. 0.0914 Ash per cent. 0.2801 Reducing sugar trace. Pol. direct degrees -0.8 Pol. invert degrees -0.7 K2SO4 Mg. per liter 0.092 A sample of Vin Mariani, as bought in the open market in an original package, has also been analyzed and found to have the following composition: Specific gravity 1.0125 Alcohol by volume per cent. 16.15 Extract per cent. 8.602 Ash per cent. 0.277 Glycerin per cent. 0.444 Volatile acids per cent. 0.0747 Tartaric acid per cent. 0.2400 Alkaloids (coca bases) ; per cent. 0.0250 Cane sugar per cent. 2.35 Reducing sugar per cent. 3.38 * Advertisements of Vin Mariani before and after national Food and Drugs Act went into effect. COUNCIL REPORTS 91 Judging from the analysis Vin Mariani corresponds to a mixture of an alcoholic extract from coca leaves and an ordi- nary Bordeaux red wine, with the addition of about 6 per cent, of sugar. The product is advertised in this country as being recommended by a host of eminent foreigners for almost everything, while Abroad, illustrious Americans are similarly quoted.-(Abstracted from The Journal A. M. A., Nov. 26, 1906.) WATERBURY'S METABOLIZED COD-LIVER OIL COMPOUND Report of the Council on Pharmacy and Chemistry and Lab' oratory Contribution on Which It Is Based The following report has been adopted by the Council and its publication directed. W. A. Puckner, Secretary. To the Council:-Your committee on pharmacology has read with interest the contribution from the Association's lab- oratory on Waterbury's Metabolized Cod-Liver Oil Compound.. The report shows that misleading and false statements are made in regard to the composition of the product and also that exaggerated and unwarranted claims are made for its thera- peutic value. In view of the attempt of the Waterbury Chem- ical Co. to create a false impression in regard to the thera- peutic value of the composition of its product, it is recom- mended that the following report be adopted and published: The Council believes that there is a preponderance of evi- dence to indicate that whatever therapeutic value cod-liver oil has, that value depends chiefly, if not entirely, on its fat (oil). In the opinion of the Council, the word cod-liver oil should not be used in connection with any preparation unless it consists to a large extent (25 per cent, or more) of cod- liver oil. Since Waterbury's Metabolized Cod-Liver Oil Com- pound contains no appreciable quantity of cod-liver oil, the name is incorrect and misleading, and as a cod-liver oil prep- aration it is believed to be wholly valueless. The Council has previously voted that Waterbury's Cod-Liver Oil Compound be refused recognition because of conflict with Rules 1 and 6. -(From The Journal A. M. A., Oct. 9, 1909.) [Contribution from the Chemical Laboratory of the American Medical Association] Waterbury's Metabolized Cod-Liver Oil Compound W. A. Puckner and L. E. Warren A full page advertisement of Waterbury's Metabolized Cod- Liver Oil Compound appeared in the Iowa Medical Journal, 92 PROPAGANDA FOR REFORM March 15, 1909, in the form of a letter purporting to give the results of an analysis of the product made for the firm by a Chicago chemist. In this letter-advertisement the chemist states at the outset that the results of his examination "are somewhat at variance with the statements made in The Jour- nal." These statements he quotes as follows: 1. It is a clear liquid and no globules of oil are seen under the microscope. It is therefore not an emulsion. 2. It is of acid reaction when mixed with water and remains clear when strongly acidified. Hence it does not contain a soap, and is not a saponification of fat. 3. It mixes with water without precipitation, hence, it can not contain more than traces of a fatty acid. The chemist admits in his letter to the firm that his analyses verify statements 1 and 3, but regarding statement 2 he says: "I find that your preparation is acid in reaction, but when strongly acidified gives a distinct turbidity within 10 minutes and a voluminous precipitate within 1 hour. This precipitate is shown to consist of fatty acids of cod-liver oil, which are thrown down by the splitting of the soaps, on acidifying either with sulphuric or hydrochloric acid." From these results he states that to him it seems that the "preparation does not deserve the statement that it contains no soap, as there is no question whatever of the presence of cod-liver oil." While in the letter published in this advertisement the chem- ist claims to have demonstrated the presence in the product of "saponified cod-liver oil" he omits to mention the quantities of the soap present. In the article that originally appeared in The Journal (Oct. 13, 1906), in addition to the three para- graphs quoted by the chemist, the following statements were made: "By these simple tests a physician is easily able to demon- strate that the preparation does not contain cod-liver oil. It is therefore valueless for the purpose of nutrition for which we give the oil. More careful analysis confirms the results of these tests and shows that it contains no fat or fatty acids (except the merest traces) ..." At the time these statements were published in The Jour- nal, the St. Paul Medical Journal, October, 1906, contained an advertisement for Waterbury's Metabolized Cod-Liver Oil Compound, which contained this statement: "The only tasteless preparation on the market which contains Cod-Liver Oil in its entirety. The metabolized product is obtained by the action of digestive ferments on pure Cod-Liver Oil." COUNCIL REPORTS 93 In the Ohio Medical Journal of Feb. 15, 1907, there ap- peared in the form of an advertisement what purported to be an analysis of Waterbury's Metabolized Cod-Liver Oil Com- pound by Prof. C. N. Kinney of Drake University. While Professor Kinney made a quantitative analysis of the prepara- tion the quantities were omitted from the analysis as pub- lished. A footnote added by the Waterbury Chemical Com- pany called attention to this fact and closed as follows: "Any physician who is not satisfied with the analysis we will be only too glad to furnish the complete analysis by our repre- sentatives." If this weirdly constructed sentence meant anything, it meant that the complete analysis would be furnished on re- quest. Such requests to the company, however, from various sources failed to elicit the information required nor was the "complete analysis" forthcoming. The inference to be drawn is fairly plain. In a circular accompanying the product as sold at present, this statement occurs: WATERBURY'S METABOLIZED COD LIVER OIL COMPOUND With Creosote and Guaiacol or Plain DOES CONTAIN COD LIVER OIL DOES ALLAY FERMENTATION DOES AID DIGESTION DOES ASSIST ASSIMILATION BUT DOES NOT DISTURB THE STOMACH As previous examinations disclosed only the merest traces of cod-liver oil in the product while claims were made that it "represents cod-liver oil in its entirety," and in view of the fact, too, that present advertisements emphatically declare that cod-liver oil is present in the preparation as now sold, it was thought best to examine some of the preparation with especial reference to the quantities of fatty acids from cod- liver oil. The results of the examination are breifly as follows: The total quantity of acids isolated amounted to about 0.3 per cent., and of this amount about two-thirds was salicylic acid. Thus it appears from the examination of the specimens bought on the open market that the preparation contains at most but 0.1 per cent, of the fatty acids from cod-liver oil, a totally insignificant quantity. 94 PROPAGANDA FOR REFORM Notwithstanding the protestations by the manufacturers, in the form of published analyses and circulars, it is seen that the statements published in The Journal, Oct. 13, 1906, p. 1207, are essentially substantiated; it is further evident that the product does not deserve to be designated as a cod-liver oil preparation. To obtain a medicinal dose of cod-liver oil the patient would be compelled to swallow the contents of a bot- tle of this mixture, and as, the product contains 11 per cent, alcohol the patient who did so would probably experience a degree of exhilaration not referable to cod-liver oil.-(From The Journal A. M. A., Oct. .9, 1909.) Declared Misbranded This product of the Waterbury Chemical Company, of Des Moines, Iowa, was exposed in The Journal of the American Medical Association, October 9, 1909. In May, 1910, the OLD LABEL NEW LABEL It is interesting in this connection to i^ite that this product is no longer being sold in the United States under the name "Metab- olized Cod Liver Oil Compound." In Canada and Great Britain, however, were the Food and Drugs Acts do not require the same degree of truthfulness in labeling, the old name is still retained. See the illustrations of the old and new labels. United States Government issued a notice of judgment in which it was declared that Waterbury's Metabolized Cod Liver Oil Compound was misbranded. The court rendered its decree of condemnation and forfeiture.-[Notice of Judgment, No. 303.'] PART IL CONTRIBUTIONS FROM-THE CHEMICAL LABORATORY ANUSOL HEMORRHOIDAL SUPPOSITORIES W. A. Puckner and L. E. Warren An abstract of an article concerning "anusol suppositories" was published in The Journal, Jan. 23, 1909. This gave the results of an analysis by a foreign chemist, J. F. Suyver, which were to the effect that "anusol suppositories" contained no "anusol." Schering & Glatz, the American agents for "anusol" suppositories, took exceptions to the abstract, asked that The Journal retract, and submitted the findings of a chemist in support of their claim that the suppositories do con- tain "anusol." To determine the composition of "anusol hemorrhoidal suppositories" as they are found on the American market, trade packages were purchased (April 6, 1909) and submitted to examination1 in the Association's laboratory. According to the claims of the manufacturers, 12 suppos- itories contain: "Anusoli 7.5 grams "Zinc oxid 6.0 grams "Balsam Peruv 1.5 grams "01. theobrom 19.0 grams "Ungt. cerat 2.5 grams" Calculated to percentages the formula reads: Anusoli 20.54 per cent. Zinc oxid 16.44 per cent. Balsam Peruv 4.11 per cent. 01. theobrom. 52.06 per cent. Ungt. cerat 6.85 per cent. When this product was submitted to the Council some time ago, Schering & Glatz stated that, according to the manu- facturer, "anusol" is the "iodo resorcin sulphonate of bismuth, having the following rational formula: [C0H2ISO2.O (0H)2]8Bi. In the meta-dioxybenzol C8H4(0H)2, the resorcin, one H has 1. Details of the quantitative analysis of "Anusol Hemorrhoidal Suppositories" appear in the annual report for 1909 of the Chemical Laboratory of the American Medical Association. 96 PROPAGANDA FOR REFORM been replaced by one I, and for another H the sulfonic-acid group So2-OH has been substituted, so that meta-dioxybenzol is transformed into C6H21SO2-OH(OH)2. In the sulfonic acid the H of OH is replaced by Bi and, as Bi is trivalent the above rational formula results.'-' According to this formula "anusol" should contain: lodin 32.99 per cent. Sulphur 8.34 per cent. Bismuth 18.07 per cent. And the "anusol" suppositories should contain: lodin 6.77 per cent. Sulphur 1.71 per cent. Bismuth 3.71 per cent. Examination showed that the suppositories contain about 0.08 per cent, iodin, or 1.2 per cent, of the amount claimed; 0.28 per cent, sulphur, or 16.3 per cent, of what is claimed; 0.71 per cent, bismuth, or 19 per cent of what is claimed; and zinc equivalent to 16.5 per cent, zinc oxid, or about 100 per cent, of claim. From the standpoint of the iodin content alone, assuming that all of the iodin found is present in the form of "anusol," the results of the examination of the product (as found on the American market) verifies, for all practical purposes, Suyver's statement that "anusol suppositories contain no anusol," for the quantity of iodin present is so minute (about 1/82 of that required by the formula) as to be unworthy of serious con- sideration. The presence of sulphid in appreciable amounts was demonstrated showing that the sulphur is present, at least in part, in the form of sulphid and not as sulphonate as is claimed. In a measure, too, this is in accord with the findings of Suyver, who concluded that, in the product which he ex- amined, the bismuth was present in the form of sulphid. The proportions of sulphur and of bisniuth (respectively about 1/6 and 1/5 of the required amounts) indicate still further that the product is not all that it is claimed to be. A specimen submitted by Schering & Glatz to the Council two years ago contained 0.09 per cent, iodin, or 1.3 per cent, of the amount claimed; 0.23 per cent, sulphur, or 13.4 per cent, of the claimed amount; and 0.52 per cent, bismuth, or 14 per cent, of what is claimed by the formula. Since the above determinations were made another specimen of Anusol Hemorrhoidal Suppositories was received from Schering & Glatz, July 16, 1909. This sample was found to contain about: 0.075 per cent, iodin, or 1.1 per cent, of the amount re- quired by the formula; 0.265 per cent, of sulphur, or 15.5 LABORATORY CONTRIBUTIONS 97 per cent, of the requirement and 0.88 per cent, bismuth, or 23.7 per cent, of the required amount. It will thus be seen that the composition of the oldest specimen and also that of the specimen recently sent, corresponds in a general way with that of the one first examined. Whether judgment be based on the determination of the bismuth, the sulphur or the iodin, the results just given clearly show that the claims made concerning the composition of "Anusol Hemorrhoidal Suppositories" are not substantiated by the facts.-(From The Journal A. M. A., Oct. 2, 1909.) AROMATIC DIGESTIVE TABLETS W. A. Puckner and L. E. Warren It has been amply demonstrated1 that pepsin and pancreatin, when in solution, mutually destroy each other; if the splution be acid, the pepsin destroys the pancreatin; if alkaline, the pancreatin destroys the pepsin. By using the character- istic effect of pepsin on proteids in acid medium and that of pancreatin on proteids and starches in an alkaline solution it can readily be demonstrated that commercial liquid prepara- tions labeled as containing both of these ferments actually contain only one ferment. They are misbranded. Besides the liquid a goodly number of solid preparations, chiefly tablets, containing pepsin and pancreatin are offered to the profession. Among these are tablets consisting simply of pepsin and pancreatin. Since pepsin and pancreatin inter- act only when in solution, it is quite possible to prepare tab- lets which contain these ferments. The use of these tablets is unscientific, since one or the other of the ferments is destroyed when it comes in contact with the fluids of the digestive tract. In addition to simple tablets containing pepsin and pancreatin only there is at present a host of "digestive tablets" on the market. Among these- are some which must be classed with the "digestive impossibilities" (Reports of the Council on Pharmacy and Chemistry, 1910, vol. 1, p. 41). The preparations referred to are tablets claimed to contain pepsin, pancreatin, diastase, hydrochloric acid and lactic acid. When it is considered that the United States Pharmacopeia defines hydrochloric acid as "a liquid composed of 31.9 per cent, by weight of absolute hydrochloric acid (HC1=36.16) and 68.1 per cent, of water," i. e., a solution 1. U. S. Pharmacopeia, 8th revision, p. 334; The Journal A. M. A., Feb. 2, 1907, and Feb. 9, 1907. 98 PROPAGANDA FOK REFORM of hydrogen chlorid, a gas, in water, it would at first appear that the incorporation of any appreciable quantity of hydro- chloric acid in tablets would be impracticable. Hydrochloric acid, however, possesses to a limited extent the property of combining loosely with protein substances so that it becomes possible to bring about its combination with pepsin and sim- ilar substances to form compounds which are relatively stable at ordinary temperatures. Because of the volatility of the free acid and its limited combining power with protein sub- stances (100 gm. boiled beef combine with 2 gm. absolute hydrochloric acid2), the quantity of acid in any tablet can never be large, much less than sufficient to be of any thera- peutic value. A number of firms offer "digestive tablets" for sale having formulas of which the following may be considered typical: Sacch. Pepsin 4 grains Pure Pancreatin 1 grain Diastase % grain Aromatic Powder % grain Lactic Acid % grain Hydrochloric acid % grain Some manufacturers use United States Pharmacopeia pepsin in place of the saccharated article; others do not give the exact quantities of hydrochloric acid which their product is supposed to contain, but make use of the indefinite expres- sion "q. s.;" still others state merely that hydrochloric acid is present, but make no claim whatever concerning the quantity. From purely theoretical considerations it is possible that the tablets referred to might contain appreciable amounts of hydrochloric acid. Since the formulas for some of the tablets furnish no information concerning the content of hydrochloric acid, it seemed worth while to determine the quantity, if any, actually present in some of the tablets on the market. Accord- ingly a trade package of "digestive aromatic tablets," as put up under the label of each of six American manufacturers, was purchased and submitted to examination in the Associa- tion laboratory. Qualitative tests made on specimens from each brand of tablets demonstrated the absence of uncombined hydrochloric acid in each. Further tests3 showed that hydrochloric acid in 2. Hemmeter, Diseases .of the Stomach, Edition 3, p. 250. 3. The details of the analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Associa- tion. LA BOR A TOR Y CON TRI BUTTONS 99 protein combination was present essentially in the amounts claimed in three of the specimens. In two of the others hydrochloric acid was entirely absent; in the remaining one only the merest traces of hydrochloric acid could be found. H. K. Mulford Company "DIGESTIVE AROMATIC" "Pepsin, Sacch 4 grains "Pancreatin 1/2 grain "Diastase 1/16 grain "Acid Lactic 1/8 grain "Acid Hydrochloric 1/8 grain "Aromatic Powder 1/4 grain Dose: 1 or 2 tablets. In the above formula each tablet is said to contain % grain hydrochloric acid. This amount is equivalent to 0.002584 gm. (1/25 grain) absolute hydrochloric acid. Analysis demon- strated that each tablet contains about 0.00267 gm. hydro- chloric acid (absolute HC1) or essentially the amount claimed. The average dose of diluted hydrochloric acid United States Pharmacopeia is 1 c.c., equivalent to 0.1049 gm. absolute hydrochloric acid. To obtain this quantity from the above preparation the patient would be required to swallow more than three dozen of the tablets. Wm. S. Merrell Chemical Company "DIGESTIVE AROMATIC, 5 GRAINS" 'Tepsin .. 80 parts "Pancreatin 10 parts "Diastase 1 part "Acid Lactic 1 part "Acid Hydrochloric 3 parts "Aromatic Powder 5 parts Calculation shows that each tablet should contain about 0.0031 gm. of absolute hydrochloric acid. The analysis indi- cated that each tablet contains about 0.0030 gm. hydrochloric acid (absolute HC1) in protein combination, or practically the amount claimed. One pharmacopeial dose of hydrochloric acid is contained in 35 of the tablets. Parke, Davis & Company "DIGESTIVE AROMA TIG" "Saccharated Pepsin 4 grains "Pure Pancreatin 1 grain "Diastase y^ grain "Aromatic Powder % grain "Lactic Acid. "Hydrochloric Acid. Dose: 1 to 3 tablets. 100 PROPAGANDA FOR REFORM Chlorid is present in small amounts, but quantitative exam- ination indicated that hydrochloric acid, either free or in protein combination, is absent. An ammonium salt is present in small quantities. Sharpe & Dohme "DIGESTIVE AROMATIC" "Pepsin, Sacch., U. S. P 4 grains "Pancreatin, pure 1 grain "Diastase % grain "Aromatic Powder % grain "Lactic Acid q. s. "Hydrochloric Acid q. s. Small quantities of chlorid are present. Quantitative exam- ination indicated that hydrochloric acid in protein combina- tion is present only in very small amounts, each tablet con- taining but about 0.00034 gm. of absolute acid, or about 0.34 per cent, of the pharmacopeial dose. Ammonia is absent. Inasmuch as more than 300 of these tablets would be required to furnish a pharmacopeial dose of hydrochloric acid, this firm's interpretation of the expression "q. s." would prove interesting. Truax, Greene & Company "SYNERGIA." "Synergia" is claimed to be composed of "pepsin, pancreatin, veg. diastase, lactic acid, hydrochloric acid and aromatics; dose, 1 to 3 tablets." The specimen contains no hydrochloric acid, either free or in protein combination. A trace of ammo- nia and small quantities of chlorid were found. The Fraser Tablet Company "Pepsin Sacch 80 parts "Pancreatin, Pure 10 parts "Diastase 1 part "Lactic Acid 1 part "Hydrochloric Acid 3 parts "Aromatic Powder 6 parts Dose : 1 or 2 tablets. "Each tablet represents (5) grains of the above mixture." According to the formula hydrochloric acid (31.9 per cent, absolute HC1) represents 3 parts in 101 of the preparation from which the tablets are made. Each tablet (containing 5 LABORATORY CONTRIBUTIONS 101 grains of the mixture) should have 0.00307 gm. • absolute hydrochloric acid. Analysis showed that each tablet contains hydrochloric acid in protein combination equivalent to an average of 0.003066 gm. absolute hydrochloric acid, or essen- tially the amount claimed. It would be. necessary to give 34 tablets to administer a pharmacopeial dose of hydro- chloric acid. Editorial Note: The above indicates that the use of such tablets is irrational, unscientific and should be condemned. The only constituent of these tablets, other than the aro- matics, which might possibly be of benefit in stomach troubles, is the pepsin. But even if it be assumed that the diastase and pancreatin could exert their characteristic effects, their aid to digestion (metabolism) would be but slight, because their amounts in the tablets are too small to be of any value. It is claimed that the tablets contain disastase in amounts varying from 1/20 to 1/4 grain. Assuming the diastase used to be of first-class quality, i. e., capable of converting 200 times its own weight of starch into soluble products, the quantity in one tablet would be capable at the most of digest- ing but from 10 to 50 grains of starch, an amount equal at the most to but a small spoonful of oatmeal or a very dainty bite of bread. In the same way the quantity of pancreatin is insufficient to be of any material aid in digestion should it in some way escape destruction in the stomach and still retain its full activity when it reaches the alkaline juices of the intestines. One grain of pancreatin of full United States Pharmacopeia strength will digest only 25 grains of starch or the proteids in about 100 c.c. of milk. Saccharated pepsin, which was formerly official, was required to digest 300 times its own weight of moist egg albumin, while the pepsin that is now official is required to digest ten times that amount, or 3,000 times its own weight. It is evi- dent, therefore, that the tablets should contain sufficient pepsin to digest appreciable amounts of protein. No intelli- gent physician would prescribe these tablets simply for the pepsin they contain or are supposed to contain; if he wanted to give pepsin he would prescribe the drug in the simple form. Clinical experience has shown that in the majority of cases of so-called dyspepsia the stomach contents contain too much rather than too little hydrochloric acid, and wherever there is a sufficiency of acid there is usually no decrease in the secre- tion of pepsin. In many of such cases, too, digestion is 102 PROPAGANDA FOR REFORM normal, or even more active than normal, but even when it is imperfect there is seldom any lack of pepsin. Insufficient digestive power is most often due to a deficiency of hydrochloric acid and not to lack of pepsin in the stomach contents. In the tablets under consideration, however, hydro- chloric acid is present-if at all-in the most ridiculously minute quantities; quantities that are so small as to preclude any therapeutic effect except that due to the psychic element. These tablets, with their six or more ingredients, are typical "shotgun prescriptions." Such prescriptions catch the unthink- ing doctor as well as the self-drugging public, for, while clin- ieal experience and physiologic experiments have demonstrated that the old ideas regarding the value of these digestives and ferments were erroneous, the public and many members of the medical profession still seem to be influenced by the old theories. In conclusion we must not lay all the blame on the manu- facturing firms for supplying these absurd combinations; the physician who prescribes them should assume a large share of it. If the doctors did not use them the manufacturing con- cerns would soon stop putting them on the market. We hope, however, that those manufacturing concerns that like to be classed as reputable will cease to disgrace their catalogues with what they know to be therapeutic absurdities.-(From The Journal A. M. A., Aug. 20, 1910.) BURNHAM'S SOLUBLE IODIN W. A. Puckner and A. H. Clark An analysis of Burnham's soluble iodin, according to its manufacturers one of the most notable discoveries of the age, was made in the Laboratory of the American Medical Association. The results, which agree with those obtained by Wilbert and others (Proc. Am. Pharm. Assn., 1903, li, 409), indicate that Burnham's soluble iodin is a solution of iodin in alcohol made miscible with water by the presence of some iodid. It is true that this is not potassium iodid and is not, entirely at least, hydro- gen iodid (hydriodic acid), but this is of slight impor- tance compared with the fact that it is a solution in alcohol of free iodin and an iodid and, therefore, is essentially the same as Lugol's solution. It is of interest also to note that the amount of free iodin is not constant: analysis showed that one specimen, after standing for a month, contained LA BO RA TORY CONT RI BUT IONS 103 nearly 40 per cent, more free iodin than it did when first pur- chased. The amount of iodin found corresponds approximately to 3.0 gm. of free iodin and 2.0 gm. of combined iodin in 100 c.c. of the solution. Lugol's solution contains 5.0 gm. of free iodin and 10.0 gm. potassium iodid in 100 c.c. Burnham's soluble iodin tablets, each said to contain three minims of Burnham's soluble iodin, were also analyzed. The details of this analysis show that the tablets contain approximately one-fourth the amount of free iodin and approximately two- thirds the amount of total iodin that should be contained to agree with the label. The outcome of the analyses is not a surprise, since the extravagant claims made by the Burnham Soluble lodin Company are enough to condemn their product. Physicians will be perfectly justified in looking with suspicion on all such unscientific claims of specially important secrets possessed only by drug manufacturers, especially when not substantiated by painstaking analyses. Whenever it is desired to administer free iodin, Lugol's solution (Liquor lodi Com- positus, U. S. P., Physician's Manual, p. 84) is an inexpensive and perfectly available preparation.-(Abstracted from The Journal A. M. A., March 28, 1908.) "HYDROCYANATE OF IRON-TILDEN" W. A. Puckner and W. S. Hilpert Among the many inquiries received regarding the composi- tion of secret remedies was one in reference to "Hydrocyanate of Iron" manufactured by The Tilden Company, New Lebanon, N. Y. This preparation is advertised as being "unexcelled as a remedy for epilepsy, hysteria, chorea, neurasthenia, locomo- tor ataxia, neuralgia, migraine, anemic headaches, and all convulsive or reflex neuroses dependent on impairment of the brain or spinal cord." It is also said to be "valuable in uterine reflex neuroses due to congestion; in amenorrhea due to anemia and chlorosis and suppressed menstruation." The term "hydrocyanate of iron" is an unfamiliar one and is not found in any available reference work on chemistry. Thinking that the term might have been loosely applied to ferrocyanid of iron, or Prussian blue (a compound once sug- gested for epilepsy, but long ago considered useless), the cor- respondent wrote to the manufacturers asking if such were the' case. The Tilden Company answered: "... our preparation Hydrocyanate of Iron is not Prussian blue in any sense of the word. Prussian blue has no curative prop- 104 PROPAGANDA FOR REFORM erties as applied to all forms of epilepsy. Prussian blue is Ferro- cyanid of Iron while our preparation is Hydrocyanate of Iron."' The only statements in the Tilden Company's advertising matter, regarding the composition of hydrocyanate of iron are the following: "Hydrocyanate of Iron (Tilden's) is a correct and scientific com- bination of well known principles." "Hydrocyanate of Iron (Tilden's) combines well known proper- ties of ferruginous salts with the sedative action of Hydrocyanic acid." The last statement would lead one to expect the pres- ence of available iron and cyanogen ions. In fact, the in- ference to be drawn from all the company's "litera- ture" is that "hydrocyanate of iron" is a definite chemical compound in the same sense as is ferrocyanid of iron, and that inference is still further borne out in the letter to our cor- respondent. This being the case, the Tilden Company was again written to and asked for the chemical formula of "hy- drocyanate of iron," with the following result: "Replying to your inquiry regarding the formula of Hydrocy- anate of Iron we beg to state the composition of this preparation is a trade secret and we therefore do not care to furnish the de- sired information." This reply verified the opinion already formed that "hydro- cyanate of iron" is a secret preparation. Its analysis was then taken up in the Association's laboratory. EXAMINATION OF THE TABLETS The product appears on the market in cartons said to con- tain one ounce of one-grain tablets. On the cartons, in addi- tion to the name of the preparation and the name and address of the manufacturers, are the names of diseases for which it is recommended. The tablets, in the specimens analyzed, were dark blue, rather hard and slightly bitter in taste and had an average weight of 0.1382 gm., or about 2 grains. They were found to be practically insoluble in water and dilute mineral acids; aqueous oxalic acid solution partially dissolved them, yielding a blue solution. Boiling with alkali hydroxid solu- tion decomposed the tablets, yielding iron in an insoluble form and a solution of alkali ferrocyanid, as demonstrated by the appearance of a deep blue precipitate on the addition of ferric chlorid solution. The portion insoluble in alkali when boiled with hydrochloric acid yielded a solution contain- ing iron, approximately equivalent to 50 per cent. Prussian blue. These properties are all characteristic of Prussian blue and, taken together, identify Prussian blue as a constituent of "hydrocyanate of iron (Tilden.)" The insoluble residue from the iron determination possessed the propeictieg and con- LABORA TORY CONTRIBUTIONS 105 stituents of talc and constituted practically one-half of the tablets. Extraction of the tablets with chloroform or ether in the presence of ammonium hydroxid yielded a small amount of organic material which contained bodies having the prop- erties of, and responding to tests for, quinin or cinchona alka- loids and caffein. The presence of a salicylate was also indi- cated.1 From the analysis it is concluded that "hydrocyanate of iron (Tilden)" is essentially a mixture of approximately equal parts of talc and Prussian blue, containing traces of organic matter having the general properties of alkaloids. Comment: When a firm exploits an abandoned remedy for so hopeless a disease as epilepsy under a name not known to chemistry and with a false representation of its pharmacologic qualities, such action may rightly be assumed to show ig- norance or worse. "Hydrocyanate of iron," if it means any- thing, means the cyanid of iron, but the preparation put out under that name is, according to our chemists, not cyanid of iron, but the ferrocyanid of iron commonly known as Prus- sian blue. This substance has been tried for epilepsy and abandoned. Yet the firm recommends it as a "peerless remedy" for this disease. "The Tilden Company holds the key to the situation in the treatment of epilepsy. We have the remedy that does the work." Not that epilepsy is the only disease for which this hypo- thetical chemical compound may be prescribed. Torticollis has been "successfully treated with hydrocyanate of iron." In chorea, we are told "a richer and better blood supply" should be furnished the nervous and vascular system and "the irri- tation of the motor centers" must be allayed. "Hydrocyanate of iron serves admirably to accomplish both of these purposes. It carries the hemoglobin to the blood in its most easily assimilable form and its hydrocyanic acid possesses remark- able sedative powers . . . . " It is not possible for it to have any value in anemia because of its insolubility, yet we are told: "In conditions marked by poverty of the blood producing anemia or chlorosis, reacting on the nervous system and calling for a cha- lybeate, hydrocyanate of iron (Tilden's) takes a front rank among the remedies of this class, combining as it does the blood enriching qualities of ferrum with the sedative action of hydrocyanic acid." As Prussian blue yields no appreciable quantity of hydro- cyanic acid under the conditions existing in the animal or- 1. Details of the quantitative analysis of "Hydrocyanate of Iron-Tilden" appear in the annual report for 1909 of the Chemical Laboratory of the American Medical Association. PROPAGANDA FOR REFORM 106 ganism, "the sedative action of hydrocyanic acid" must be as hypothetical as the chalybeate properties attributed to it. It is strange that a manufacturer, in introducing a new chemical compound, should have to assure his customers that it "contains no opium or alkaloid, of that drug, cocain, chloral hydrate, conium or any of the bromids." Imagine a firm putting, let us say, potassium iodid-a definite chemical com- pound-on the market and solemnly guaranteeing that it con- tained no cocain or chloral hydrate! Would the Tilden Company of twenty-five years ago have served such mental pabulum in its advertising matter? One would think that the' dictates of common humanity would protect the unfortunate epileptic from the machinations of the nostrum maker, especially from the exploitation of a remedy that has been tried and found wanting. A nostrum, however, merely has to measure up to one standard: Will it pay? Meeting this requirement nothing else matters.-(From The Journal A. M. A., June 19, 1909.) HYMOSA W. A. Puckner and W. S. Hilpert Frequent requests for information regarding the composition of hymosa, manufactured by the Walker Pharmacal Co., St. Louis, and a perusal of the extensive and nostrum-like adver- tising the product is receiving, made the chemical examination of the preparation seem desirable. If the label is to be be- lieved, hymosa has been of use in "acute and chronic muscular and articular rheumatism, gout, sciatica, lumbago, pleurodynia and neuralgia, whether due to uric acid diathesis or not . . ." The composition of hymosa as given by the proprietors is set forth in the following statement: ". . . Hymosa, in which the remedies Frangula, Actea Spicata, Stellaria Media, Franciscea Uniflora, Rhus Toxicodendron, Passiflora Incarnata, Phytolacca Decandra and Echinacea Angusti- folia are combined in the proportions which experience has shown will obtain the quickest and best results without any of the stomach and heart complications so often following the administration of salicylic acid." "Contains no Salicylic Acid." Thus the explicit statement is made that hymosa contains certain vegetable drugs (most of them obsolete and valueless) and that it does not contain salicylic acid. By inference the claim repeatedly is made that the nostrum does not contain any salicylates. LABORA TORY CONTRIBUTIONS 107 ". . . Hymosa has achieved most remarkable results in over- coming rheumatism in cases where salicylates have been tried in vain . . "Salicylic acid was not successful in this case of rheumatism of the stomach." "Negative results from salicylates-Hymosa cures." ". . . the salicylates didn't help? Then we must try Hymosa." Reproduction (reduced) of an advertisement of Hymosa. This indicates the attempt made to convey, by implication, the idea that the salicylates are absent from Hymosa. Still harping on the undesirability of salicylates and the value of hymosa the advertising pamphlets state: "Salicylic Acid Replaced. The Use of This Dangerous Agent in Rheumatism Obviated." "It seems that the use of the dangerous and ineffective salicylic acid will soon be given up and hymosa take its place." "Former methods of treating rheumatism . . . have been very unsatisfactory . . . because of the heart and stomach difficulties brought on by salicylates of which most rheumatism remedies are composed." "Could not tolerate the salicylates." Finally in a letter issued to physicians we are told: ". . . you will find hymosa to possess prompt and positive curative action with the additional advantage of avoiding the heart and stomach complications, which the salicylates too often, cause." 108 PROPAGANDA FOR REFORM It is evident from the above quotations, in which the sali- cylates are denounced specifically or by implication, and from the label which states that no salicylic acid is present, that the exploiters of the nostrum deliberately intended to give the impression that hymosa is free from salicylates or salicylic acid and contains only the vegetable or plant drugs enumer- ated. The very fact that the proprietors make such repeated efforts to give the impression that hymosa is free from sali- cylates is in itself sufficient to arouse suspicion and hence in the examination particular attention was given to the detec- tion of salicylic acid or salicylates with the following results: Examination.-Hymosa as purchased on the market is a dark brown liquid with an odor of sassafras and a rather sweetish taste, reacting acid to litmus. Qualitative tests hav- ing indicated the presence of salicylate, iodid, sodium, potas- sium, alcohol and some organic matter, presumably sugars and some plant extractives, these were determined quantitatively.1 It was found that a part of the salicylate was present as free salicylic acid and part in a combined form. The sodium deter- minations indicated that all the salicylate, excepting that in the form of free salicylate acid, was present as sodium sali- cylate. From the results of the potassium estimations, it was evident that the iodin was present in the form of potassium iodid. From the results of the analysis it is believed that the prep- aration has approximately the following composition: Salicylic Acid 0.32 gm. Sodium Salicylate 1.15 gm. Potassium Iodid 0.32 gm. Sugars and extractives 4.60 gm. Alcohol, U. S. P 16.8G c.c. Water to make 100.00 c.c. These results indicate that hymosa is essentially a solution containing salicylic acid, sodium salicylate, potassium iodid, alcohol, sugars and plant extractives in the proportions given above, and show that the various statements referred to, re- garding the absence of salicylic acid and salicylates are mis- leading and untrue. It further illustrates the repeatedly dem- onstrated fact that nostrums exploited as wonderful and new discoveries are new in name only-and whatever therapeutic value they possess depends on old and tried medicinal agents. Editorial Note: In describing the methods employed by the manufacturers of Manola in exploiting their product, attention was called to the fact that the Manola Company was 1. The details of the analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Associa- tion. LABORATORY CON TRI B UT1O NS 109 reported as being a subsidiary affair of the Luyties Homeo- pathic Pharmacy Company of St. Louis. It is reported that this same company also operates the Walker Pharmacal Com- pany, which exploits hymosa and pas-avena.-(From. The Journal A. M. A., June 11, 1910.) LIQUID LIFE W. A. Puckner and L. E. Warren A physician wrote to The Journal that for six years one of his patients had been taking about fifty bottles annually of a preparation called "Liquid Life;" he requested informa- tion concerning the composition of the remedy. The inquiry was referred to the Association's laboratory. The price of the preparation being 75 cents for each bottle it seemed a pity that patients like this one should continue to be separated from their money by a nostrum which, from its name and descriptive circulars, appeared to be a sham. Hence it was explained to the correspondent that if he would send an original package of the preparation to the Association's laboratory a cursory examination would be made-sufficient in all probability to show his patient the folly of her faith in the nostrum. "LIQUID LIFE A TRUE ANTITOXINS "This antitoxine is non-poisonous and non-alcoholic. It will expel all alcohol from the system at once, and so requires a great deal more antitoxine and time to effect a cure if any alcohol is used while taking it. but you can use whatever tobacco you have been accustomed to." Arrests Diseases and Prevents the Development of Germs "All contagious diseases are germ diseases, and manifest themselves first as headache, pain in the back, lassitude and rise of temperature, at this stage a few doses of the antitoxine will arrest them at once and prevent any further development of the germs, no matter what their nature may be." The Patient Shouldn't Meddle with the Leucocytes ! "It is important that their should be no interference with the action of the leucocytes or white corpuscles by using purgatives or drugs of any kind while taking the antitoxine. If the bowels move very freely at first they will check them later, and if they do not move, wait till they do." 110 PROPAGANDA FOR REFORM An original package of "Liquid Life" having been received a cursory examination of it was made, which showed that the preparation is essentially an aqueous solution of Epsom salt, containing some Glauber's salt, the mixture being sweetened with saccharin. The facts brought out by the cursory exami- nation having shown that the preparation is an outrageous imposition on the public, it was decided to make a more com- plete investigation with the view of publishing the results. On page 109 part of the label of "Liquid Life" is shown, the spelling and diction being exactly transcribed. A paragraph taken from the circular describing "Liquid Life" is given herewith. Considering its length, it is sub- mitted as probably being the most faulty in diction, the most replete in false statements and the most barren of truthful suggestions of any paragraph in "patent medicine" literature. THE HOME PHYSICIAN Why Liquid Life Makes One First it is antitoxins to all contagious diseases and so removes the fear of infection from the family. If given early, acts as a preventive, given later subdues the disease; is non- poisonous and non-alcoholic; there are no reactions or bad effects from it no matter how long it is taken. It contains in itself everything with the exception of food that should be taken' into the stomach to keep the family in perfect health. Children born under the influence of the antitoxine, are just splendid and remain so after birth and grow up symmetrical with a healthy body and a clear brain, for when a dose of the antitoxine is given you call into action not only one physician but millions (the Leycocties) and every one of them is a supernal surgeon and their power to restore the body to health is supreme, even in those diseases that have been found difficult to cure before, such as Pneumonia, Catarrh, Appendicitis, Blood Poison from any cause, Syph- ilis, Cancer, Malignant Diphtheria, Erysipelas, Scrofula, Tetanus or Lockjaw, Consumption, all Fevers, Rheumatism, Womb diseases, Bright's Disease, Diabetes and other diseases called incurable. Ladies will find the antitoxine is all they require to keep themselves in perfect health, and if taken for a short time before confinement will relieve them of half the pain and danger. It can also be used externally with marvelous effect in all cases requiring outside applica- tions, or injected into all the orifices of the body where there is disease, in fact, being a true antitoxine, it solves the problem of Health and Disease. To those conversant with the principles of medicine the reading of the label and circulars would alone be sufficient to condemn the nostrum as a humbug. Others might, however, LABORATORY CONTRIBUTIONS 111 be impressed as strongly by this jumble of meaningless phrases and vicious misrepresentations as by a logical and truthful statement of facts. The labels indicate that "Liquid Life" is manufactured by the T. B. Chemical Co., Newark, N. J. The preparation is a pale yellow, faintly fluorescent liquid, having a faint, pepper- mint-like odor and a harsh, disagreeable taste. The presence of magnesium, sodium, a sulphate and small amounts each of saccharin, zinc and quinin was demonstrated by the usual tests. Ammonium salts were absent. The absence of cocain, morphin and their derivatives and substitutes was shown. Quantitative determinations indicated that the composition of "Liquid Life" is essentially as follows: Crystallized quinin sulphate 0.0566 gm. in 100 c.c. " ' zinc sulphate 0.2416 gm. in 100 c.c. " magnesium sulphate (Epsom salt) 13.34 gm. in 100 c.c. " sodium sulphate (Glauber's salt) (Calculated from sodium de- termination) 6.17 gm. in 100 c.c. Saccharin a trace. Water (by difference) to make 100 c.c. Secret nostrums-the so-called "patent medicines" sold to the public-are of two classes: One is harmless in itself, in that it contains but little or none of any medicinal substances and is potent for harm only in so far that it restrains the user from seeking competent treatment; the other not only keeps the sick person from receiving the treatment which is indicated but contains ingredients which, when used indiscriminately, are potent for harm. Both classes are humbugs, especially because a large price is charged for what is usually worth but a few cents. In both classes there are all degrees of humbugs. "Liquid Life" easily belongs to the second class and is an example of the worst in this class. Besides containing the poisonous ingredient, zinc sulphate, its chief ingredient is Epsom salt, the long continued use of which always does harm. When it is considered that during six years one patient consumed between $200 and $300 worth of the stuff (as sold at retail) the "degree" of the humbug may be appreciated. In connection with the claim of the manufacturer that "Liquid Life" is "a true antitoxine" the following definitions for an antitoxin are given: "A substance formed in the body, which neutralizes the poisonous products of a micro-organism; a defensive proteid." (Standard Dictionary). "Any defensive proteid developed in the body as a result of the implantation of a poison, and acting as a neutralizer of the poison." (Dorland's Medical Dictionary). 112 PROPAGANDA FOR REFORM In view of these definitions and of the findings of the analysis the absurdity of the claim that "Liquid Life" is "a true antitoxine" is patent. Inasmuch as the courts have recently ruled that under the present Food and Drugs Act it is permissible to lie as to the curative properties of a preparation so long as no false state- ments concerning its composition are made, it would be inter- esting to know whether the assertion that the remedy contains "a true antitoxine" would be considered as a violation of the law; also whether the name "Liquid Life" would be held to be a false statement as to composition, or whether the learned justices would consider the name (although a deliberate lie) a permissible claim for the virtues of the remedy.-(From The ■Journal A. M. A., Aug. 5, 1911.) MICAJAH'S MEDICATED UTERINE WAFERS W. A. Puckner and W. S. Hilpert Evidently touched by the generosity of the manufacturer in sending him a sample and literature, but not too favorably impressed by the claims made for the preparation referred to, a correspondent writes: I enclose a valuable sample and literature just received. Such a palpable humbug as Micajah's Uterine Wafers would hardly seem to need notice were it not probably true that many practitioners habituated to the use of samples are still influenced by the glowing accounts of cures wrought; especially when attested by such a name and title as "Elmore Palmer, M.D., Ex-President Western New York Medical Society." This secret gynecologic medicament is recom- mended for anything from "Pruritus Vulvae," "Enlargement of the Womb," "Displacements," "Cystocele and Rectocele," to the "Meno- pause." Following the definition that by her "stomach" a woman means anything from her chin to her knees, the ex-president with truly noble impartiality has with the wonderful Micajah wafers wrought lightning cures all the way from "stone-bruise" of the heel to nasal polyp and influenza, and some of them are male patients' too. With the foregoing as an impetus to investigate the nature of this much advertised nostrum, the wafers were submitted to analysis by the Association laboratory. The report follows: LABORATORY FINDINGS Trade packages of the wafers purchased on the open market bear the name of the preparation and that of the manufactur- ers, Micajah & Co., Warren, Pa. The label states that the nostrum is a: LABORA TORY CONTRIBUTIONS 113 "Disinfectant, astringent and local alterative of the great- est virtue. A remedy for the local treatment of the diseases of women. Inflammation, engorgement and prolapse of the womb, vaginitis, leucorrhea, menstrual derangements and the disturbances incidental to the menopause. Also highly rec- ommended for affections of the mucous membranes in gen- eral, particularly those of the nose, the throat, the rectum, and for gonorrhea, cystitis, etc." "This box contains wafers for three months' treatment." "Price per box $1.00." The box contained 25 tablets, and a circular entitled, "Hints on the treatment of diseases of women," in which directions for the treatment of many diseases are given. It ends with a paragraph which contains the following statement: "There is no doubt that the field of usefulness of Micajah's Wafers can be indefinitely enlarged by the ingenuity and therapeutic skill of the physician." Much of the advertising "literature" is in the form of leaf- lets, brochures and small pamphlets full of testimonials by physicians. Micajah's uterine wafers as found on the market are white, hexagonal tablets, odorless and possessing an astringent taste. The wafers are soluble in water with extreme difficulty. Hot hydrochloric acid and alkali hydroxids dissolve the powdered tablets readily, leaving a slight residue which under the micro- scope and by physical tests was identified as lycopodium. The acid solution of the wafers responded to qualitative tests which indicated the presence of potassium, sodium, alum- inum, sulphate, borate and a mere trace of a fatty material. Quantitative estimation of boric acid, aluminum, sulphate, sodium and potassium were made, which indicated that Mica- jah's Uterine Wafers consist of alum more or less anhydrous or "burnt," boric acid and borax in approximately the follow- ing proportions:1 Alum, dried 59.86 per cent. Borax, dried 15.62 per cent. Boric acid 5.67 per cent. Water of hydration 18.85 per cent. The average weight of the tablets is 0.7791 gm. (11.8 grains) and allowing for the fact that the quantity of water present in commercial exsiccated alum varies, each tablet would contain approximately 0.4986 gm. (7.8 grains) burnt alum; 0.2337 gm. (3.6 grains) crystallized borax, and 0.0467 gm. (0.7 grain) boric acid. 1. The details of the analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Association. 114 PROPAGANDA FOH REFORM COMMENT Judging from the "literature" that goes with the packages of this nostrum, one might imagine that it was put up abso- lutely for the layman, but this is not the case. It is advertised only in medical journals and not directly to the public; it is not necessary, for every physician who prescribes it at the same time places in the hands of his patient advertising mat- ter intended to influence that patient-and it usually does. As a result this preparation is being bought by the public direct; to what extent we do not know, but physicians are responsible for it. Probably if physicians realized that the same interests that control Piso's Consumption Cure also con- trol Micajah's Medicated Uterine Wafers they would not be so ready to act as the unpaid agents for the concern. That such simple astringents and feeble antiseptics as alum, borax and boric acid could have such remarkable curative effects on uterine diseases is absurd. The serious aspect of the matter is, that, by the encouragement given them in the adver- tising literature to treat themselves, women may neglect proper surgical or medical attention in the early stages of serious diseases such as cancer or dangerous pelvic infections, until they get beyond the hope of proper management. But when nostrum promoters urge the use of such inefficient rem- edies in the treatment of gonorrhea, it is time to look at the matter seriously. Considering the vital social significance of the venereal diseases, the employment of useless remedies can only favor the spread of these infections, which cause such a large proportion of the diseases which afflict women particu- larly. The medical profession for the most part has become men- tally calloused to the exaggerated claims of the nostrum makers and does not make sufficient effort "to condemn them. There may be some physicians, however, who use such prepara- tions as these wafers in their practice, as is indicated by the circulars, wherein the manufacturers suggest that their "use- fulness can be indefinitely enlarged by the ingenuity and therapeutic skill of the physician." It is only occasionally that a physician voices his indignation as to these humbugs, as in the case of the physician whose letter is quoted above.- (From The Journal A. M. A., March 26, 1910.) The Firm Replies To the Editor:-We have read with interest the report of your committee on pharmacology recently published in The Journal, on the subject of Micajah's Medicated Uterine Wafers, and your comments thereon. LABORATORY CONTRIBUTIONS 115 We are of the opinion that, in your laudable efforts to reform the practice of pharmacology, it is not your desire or intention to act other than justly and fairly, and therefore, with this belief, we submit the following statements for your consideration, with the hope that you will see fit to publish them. 1. We do not seek by word or deed the patronage of the laity, and what few sales are made to the public are not of our contriving, nor should we be held responsible for them, any more than is the manufacturer of quinin to be blamed for the universal use of that drug. 2. Our literature should not be considered extravagant, for it is for the most part made' up of clinical reports received from physicians and based on the unsolicited testimonials in our possession from hundreds of practitioners, many of whom have used Micajah's Wafers in practice from five to twenty years and they are therefore as well grounded as are the clin- ical reports concerning any preparation. 3. In the past year we have endeavored to place our prepara- tion on a higher ethical basis by stating in our advertisements what our wafers contain, and by eliminating whatever seems to us open to criticism. 4. That the ingredients of the preparation are "simple" is no reason for considering them valueless. H. A. Kelly, in his work on medical gynecology, page 266. recommends these ingredients in a variety of conditions. Handler also made important recommendations bearing on this subject in his "Medical Gynecology," 1909 edition, page 472. We feel we have the right to recommend this preparation for these and similar conditions, especially when our statements are backed up by the clinical experience of numerous general practitioners. 5. That the owner of Micajah's Wafers holds stock in a corporate firm which manufactures proprietary medicines and toilet articles, advertised to the laity, should not militate for oi' against our right to market a meritorious preparation on strictly ethical lines to the medical profession, inasmuch as many of the largest drug houses cater to both the doctor and the proprietary interests, and several are actively engaged in exploiting so-called nostrums. 6. We enclose a recent advertisement which has been accepted after investigation of our methods by careful medical journals, and we now believe we are conducting our business in entire conformity 'With the best interests of the medical profession and we feel certain of the true merits of our article. Micajah & Company, Warren, Pa. [Comment: This letter brings out still more strongly the points raised in the article which appeared in The Journal, March 26, 1910. Being unable to analyze motives we must perforce, accept Micajah & Co.'s statement that they "do not seek by word or deed the patronage of the laity." In 116 PROPAGANDA FOR REFORM the comments on the laboratory's report it was very explicitly stated that this nostrum was advertised only in medical journals and not directly to the public. Inasmuch, however, as the container in which this product comes has printed on it the various diseases in which the "wafers" are indi- cated, as, moreover, within the container there is a leaflet which describes in detail the use of the preparation in a list of pathologic states varying from "enlargement of the womb" to "gonorrhea in the male," and, finally, as the name "uterine wafers" would seem in itself to be a plain bid to the public, we still maintain that "one might imagine that it was put up absolutely for the layman." The proposition that advertising matter should not be con- sidered extravagant because it is largely "made up of clinical reports received from physicians" is an argument that is as old as the nostrum business itself-and as fallacious as it is old. Unfortunately, as our files show, the most extravagant statements made for proprietary products frequently emanate from men who legally are entitled to write M.D. after their name. Because a Buffalo physician details the marvelous results from the use of Micajah's Medicated Uterine Wafers in forty-three cases comprising no fewer than thirty-six path- ologic conditions from "otitis media" to "injured toe," and from "bunion" to "ophthalmia neonatorum," does not exempt such "literature" from the charge of being not merely extrava- gant, but ridiculously so. As Micajah & Co. say, because the ingredients of their preparation are simple is no reason for considering them valueless. On the contrary, if the "wafers" were truthfully exploited for what they are and what they will do, their very simplicity would be a virtue. But such has not been done. And therein lies the viciousness of nostrums. Simple mixtures of well-known drugs are foisted on the medical profession with no hint as to their composition and with claims made that are not only false, but would immediately be recognized as absurd, if their actual composition were known. That a mixture of borax and alum may be of value in some of the simple ailments of the, female genital tract can easily be granted. That relief might follow the use of sup- positories made of these ingredients-especially when sup- plemented by an increased attention to simple cleanliness- can also be admitted. To say, however, that such medicaments will quickly and permanently cure gonorrhea, urethritis, endo- metritis, etc., is foolish, false and vicious.]-(From The Jour- nal A. M. A., April 16, 1910.) LABORATORY CONTRIBUTIONS 117 NOITOL AND ANADOL W. A. Puckner and L. E. Warren Noitol The Journal received an inquiry concerning the composition of Noitol, a preparation which is being advertised to the med- ical profession as a "specific" for the cure of eczema and certain other cutaneous diseases. The preparation is manu- factured by the Wheeler Chemical Works, Chicago. Trade packages of Noitol were purchased and examined in the Asso- ciation laboratory. On the label of the package, Noitol-an inversion of the word "lotion"-is described as follows: NOITOL (Dr. Bradbury's Eczema Lotion.) For External Application Only I Our Most Popular Specialty. A specific for the cure of Eczema, Scrofulous and Syphilitic Eruptions, Lupus, Salt Rheum, Tetter, Itch, This remedy is composed of valuable Oils, combined with Vegetable and Mineral Acids in such proportions as cause a rapid and permanent cure of the above complaints. Noitol is a clear, nearly colorless, acid solution, the greater portion of which is water. Its specific gravity is 1.0097 at 25 C. Qualitative tests demonstrated the presence of a chlorid, a nitrate, a mercuric salt, free acid and glycerin. No "oils" or "vegetable acids" could be found. The analysis1 of the preparation indicated that its compo- sition is essentially as follows: Mercuric Chlorid 0.0463 gm. in 100 c.c. Mercuric Nitrate 0.0450 gm. in 100 c.c. Glycerin 1.3021 gm. in 100 c.c. Nitric Acid 1.0265 gm. in 100 c.c. Water (by difference) 98.5545 gm. in 100 c.c. From the above it appears that Noitol is simply a weak, acid solution of mercury salts-the total being approximately equivalent to a 1 to 1,000 bichlorid of mercury solution- exploited under a meaningless name. It is but one more example of the old, old story of a well-known remedy being sold at a high price under a name which is in no way indic- 1. The details of the analysis are published in the annual report for 1910 of the Chemical Laboratory of the American Medical Asso- ciation, 118 PROPAGANDA FOR REFORM ative of its composition, and under claims which are absurdly false. The price of the mixture is $2.00 a pint; the estimated cost, exclusive of the container, is about 6 cents a gallon, or, put another way: the price of a pint bottle, it is estimated, would make a barrel (31 gallons) of the nostrum. The incor- rect statement made concerning its components, the unwar- ranted therapeutic claims made for it, and the exorbitant price easily place Noitol in the front rank among the "patent med- icine" frauds. Yet it is advertised to physicians as an ethical proprietary and is evidently being prescribed by them. Anadol In the circular matter accompanying the trade package of the preparation, "Noitol," described above, a preparation called "Anadol" is described. Anadol is claimed to be an analgesic and antipyretic. In the descriptive circular there is no information concerning the composition of the prepara- tion, but from the general therapeutic description the physi- cian might easily be led to believe that "Anadol" is a distinct chemical substance. To reduce temperature the physician is advised to push the administration of Anadol in 10 grain doses until the febrile condition is under control or until a maximum of 70 grains of the preparation has been ingested. The circular further states: . . . in this lies the special value of ANADOL ; there are no annoying by-effects; the stomach bears the remedy well and neither circulation, respiration, nor the nerve centers show the least disturbance." As no evidence could be obtained concerning the composi- tion of Anadol and, as the preparation is being brought to the attention of physicians by means of circulars in connection with the distribution of Noitol, it seemed worth while to take up its examination in the Association laboratory. Accordingly a trade package of the material which had passed into inter- state commerce was purchased. Qualitative tests demonstrated the presence of sodium, a carbonate, caffein and acetanilid, the latter in considerable quantities. Analysis2 indicated that the composition of the specimen examined is essentially as follows: Acetanilid 79 per cent. Caffein 1 per cent. Sodium bicarbonate 20 per cent. 2. The details of the analysis are published in the annual report for 1910 of the Chemical Laboratory of the American Medical Asso- ciation. L.1 BO RA TOR F CO N TRI BUT 10 NS 119 Since, according to the circular, it is permissible to pre- scribe 70 grains of this preparation within 2% hours, a patient thus treated would receive no less than 55 grains of acetanilid! In view of the numerous cases of poisoning due to the misuse of acetanilid ("The Harmful Effects of Acetan- ilid, Antipyrin and Phenacetin," U. S. Dept. Agric., Bur. Chern., Bull. No. 126) the physician should be apprised of the composition of Anadol. Editorial Note: The chemical investigations reported above emphasize once more the need of such an institution as the Association's laboratory and again demonstrate the value of its work. At first sight it seems disheartening to find that physicians are so easily humbugged. Yet when it is remem- bered that it is impracticable for physicians either to analyze such products themselves or to go to the expense of having chemists do it for them, it is evident that the fault lies not so much with the physicians as with the conditions that make the exploitations of such frauds possible. It is on the. public that the burden ultimately falls, for it is the layman who has to pay two dollars for a few cents' worth of medicine. But-and this is far more serious-that the physician should be urged to dose his patient with an insidiously dangerous drug to a point far beyond the limits of safety, is little less than criminal. Yet so long as unknown medicinal products are prescribed just so long will this danger be a very real one. -(From The Journal A. M. A., May 21, 1910.) Anadol Declared Misbranded Anadol was analyzed at the Bureau of Chemistry and the chemists reported that it contained over 82 per cent, of ace- tanilid. As the labels did not bear any statement as to the quantity of acetanilid contained in the nostrum, the stuff was declared misbranded and the defendant, on pleading guilty, was fined.- [Notice of Judgment, No. 795.] OXYGENOR KING* W. A. Puckner and L. E. Warren A decade ago Dr. N. C. Morse of Eldora, Iowa, called atten- tion1 to three mechanical frauds which he had investigated and which were being exploited for the cure of disease. These instruments were known, respectively, as the "Electropoise," * This and similar fakes are discussed at some length in the book "Nostrums and Quackery," American Medical Association Press, $1.00. 1. The Journal A. M. A., Dec. 1, 1900, p. 1404. 120 PROPAGANDA FOR REFORM the "Oxydonor Victory" (illustrated on page 121), and the "Oxygenor King" (illustrated on page 122). The "Electropoise" consisted of a metallic cylinder, called "Polizer," 3% inches in length, and weighing about 5 ounces, to which an uninsulated cord was attached. To the distal end of the cord a small disc was attached and by means of an elastic band and buckle the disc could be fastened to the wrist or ankle of the patient. On sawing into the "Polizer" it was found to be hollow and empty. The price of this instru- ment was $10.00. The "Oxydonor Victory" resembled the "Electropoise" very closely. Its cylinder, called the "Vocor," was composed of brass, was 2% inches in length and its weight was about 5 ounces. Inside the cylinder a stick of carbon, such as is used by electricians, was found sealed at either end by sealing wax. The price of this appliance was originally $35.00, but at the time of Dr. Morse's investigation it could be pur- chased for $10.00. The "Oxygenor King," while similar in a general way to the other instruments, was somewhat more complex. It con- sisted of a brass cylinder 5% inches in length and weighed 24 ounces, from each end of which an insulated cord extended, one terminating in a copper disc and the other in a disc of zinc, the discs being intended to be fastened to the limbs of the patient. On cutting into the cylinder of the "Oxygenor King," it was found to be filled with a mixture of powdered charcoal and sulphur. The price of "Oxygenor King" was $25.00 net cash. WHAT THE COURTS SAID Nothing in the composition of any of these instruments coulu possibly generate the smallest quantity of oxygen, ozone or electricity. Other than their influence as "faith healers" Dr. Morse concluded that none of them could have any "more medical virtue than a copper wire attached to a stove lid or a tin can filled with brimstone and charcoal." Dr. Morse also called attention to the fact that Dr. Hercules Sanche, the promoter of "Oxydonor Victory," had attempted to invoke the power of the courts to prevent the sale of the "Oxygenor King," but that the United States courts had decided that his instrument was not of sufficient value to entitle it to the protection of a court of equity. The matter was in the courts for some time and when the case was finally disposed of, The Journal commented on the matter editorially in part as follows:2 2. The Journal A. M. A., Jan. 11, 1902, p. 336. LA BORA TORY CON TRI BUT10 NS 121 "The court stated that these and similar fakes cannot have the indorsement of the courts when the pretended inventor cannot make or refuses to make an explanation. The court admitted that reputable witnesses testified that when sick they used some of these devices, and that they were restored to health; but the court goes on to say that there is nothing to prove that this sequence of events is in the nature of cause and effect. He remarks: Tt would be just as reasonable for an Iowa farmer to say his barn was not destroyed by the last thunderstorm because there was a This depicts the pieces of metal tubing "invented" by Hercules Sanche and named the "Oxydonor." The claim was made that it causes the human organism to thirst for and absorb the oxygen of the air." It was advertised to "quickly and infallibly cure" a list of diseases ranging from "headache" to "hydrophobia" and from "twitchings" to "tetanus." This fake is sold for from $10 to $35. lightning rod on Mount Pisgah, as for a man to say that his restoration to health was brought about by the use of an Oxydonor or an Oxygenor.' " The Oxygenor King The "Oxygenor" is now called the "Perfected Oxygenor King." One of these instruments was recently examined in the Association Laboratory. In an advertising circular this apparatus is thus described: The Perfected Oxygenor King is a scientifically constructed instru- ment capable of curing all curable diseases without drugs, employing only the oxygen of the air. It consists of a metal cylinder, especially charged with a deli- cately adjusted but permanent combination of rare and costly metals, chemical agents and conductive elements, and called a gen- erator. From the description given in the circular it appears that the "generator" is a small nickel-plated cylinder, closed at 122 PROPAGANDA FOR REFORM each end by means of a screw cap. To each of the two caps an insulated wire several feet in length is fastened, terminat- ing in a metallic plate-one a. zinc plate to be fastened to the ankle of the patient, the other a copper plate for the The "Oxygenor" is an elaboration of the "Oxydonor" fake. It, also, is supposed to "oxygenate" the simpletons who use it. Twenty- five dollars ($25) is asked for this piece of metal pipe filled with sand and sulphur. The "Oxygenator" is the latest imitation of Sanche's original fake. It is just as worthless as the others and the claims made for it are even more viciously false. Twenty-five dollars ($25) and thirty-five dollars ($35) are asked for it. wrist. A third wire called a "force-controlling cord" joins the two others at a short distance from the cylinder and may be attached to the cylinder at one of the several points by means of a screw connection. LABORA TO RY CONTRIBUTIONS 123 IIOW IT IS SUPPOSED TO WORK The method of supplying this instrument is simplicity itself. There is but one requirement, namely, that the- generator be placed in a temperature thirty to sixty degrees below that of the body. This is done by placing it on a window sill, on the floor, or in a basin of cool water. The patient then attaches the green cord to his ankle, the red cord to his wrist, and sits down, reclines on a couch or retires to bed. The instrument produces its curative effects without further notice or effort on the part of the patient, and usually without any sensation of any kind whatever except the diffused, pleasurable feeling that comes with an increase in bodily vitality. Under certain circumstances, however, the patient will break out into a gentle perspiration, and for this reason he should be careful to avoid a draught. It is possible, also, that with the force-controlling cord at "strong" he may experience some inconvenience. This can be rem- edied by attaching it to the weak connection, or "G" post. According to one portion of the circular the "instrument has been designed "to control and adapt. . . . the force governing change," whatever that may be, and its curative properties are claimed to reside in this power. In another part of the circular the reader is led to believe that disease is caused by imperfect power to absorb ozone through the skin ( ! ) and that the use of the "Perfected Oxygenor King" restores this deficiency, thereby enabling the organism to regain its normality. A list comprising the names of 121 diseases which the "Perfected Oxygenor King" is claimed to cure is given in the circular. Among these are epilepsy, heart disease, locomotor ataxia, scarlet fever, yellow fever and pneu- monia. TESTIMONIALS AS USUAL We can furnish proof that its range of cures is from Headache to Paralysis, from Blood Poison to Change of Life, from Chickenpox to Varicose Veins, from Colic to Bright's Disease, from Malaria to Dyspepsia. In fact, practically the entire list of prevalent ailments is embraced in the record of cures. In contrast to the above the following statements are also found in the circular: One of the most noteworthy features of the Oxygenor treatment is that the patient cannot possibly be injured or acquire a "habit" by its use. It is not only simple, durable . . . and manageable even by a child, but innocent ... . It cannot injure or distress even the most delicate infant. While the circular advertising the "Perfected Oxygenor King" is on the whole a jumble of distorted facts, meaningless phrases and baseless assertions, it still seemed worth while in view of the absurd claims made to examine the contents of one of the instruments. 124 PROPA GA NDA FOR REFORM WHAT IT CONTAINS The material examined (taken from the "generator") was a dull, bluish-green, odorless powder. It was made up of irreg- ular sized particles, ranging from coarse to fine. Qualitative tests demonstrated the presence of sulphur in the free state and of sand, both in considerable quantities. Small quantities of lead carbonate (white lead), free carbon (charcoal), a few particles of brass and traces of iron were present. Quantitative examination indicated3 that the composition of the material is essentially as follows: Per cent. Per cent. Sulphur G6.85 Moisture .... 0.12 Sand 29.82 Brass 0.19 Lead carbonate .., 1.64 Iron trace 0.90 Total 99.52 The examination shows that the "rare and costly metals" consist of none more expensive than copper, lead or zinc, and that the other "chemical agents" (which comprise 97 per cent, of the whole) consist of sulphur and sand in the pro- portion of 2 to 1. An examination of the cylinder from which the sulphur- sand mixture was taken reveals a curious situation. While all of the wires connected with the instrument are carefully insulated these wires and the screw posts are all attached to the surface of the brass cylinder without insulation from each other. The cylinder then, with its complex of three screw posts and "force-controlling cord," amounts to nothing more than enlargement in a conductor. In effect it is as though insulated wires were soldered on opposite sides of a tin pail or, to use Dr. Morse's illustration, on opposite sides of a stove lid. The examination of the "Perfected Oxygenor King" shows that it could not possibly generate the smallest quantity of oxygen or ozone and that it could not produce or induce any electric or magnetic phenomena whatever. Despite the emphatic statements of the exploiters (in the advertising circular) to the contrary, the only possible therapeutic effects are those easily referable to the qlement of suggestion.-(From The Journal A. M. A., Oct. 22, 1910.) 3. The details of the analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Associa- tion. LABORATORY CONTRIBUTIONS 125 SALIODIN W. A. Puckner and A. H. Clark [The Council on Pharmacy and Chemistry refused recogni- tion to Saliodin because it conflicted with Rules 1 and 6, and directed publication of the following: W. A. Puckner, Secretary.] Saliodin is sold by the Saliodin Chemical Co., Scranton, Pa. In the literature and on the trade package the following "formula" is given: | FORMULA Each Grs. XX of. Saliodin contains approximately: B Salicylic Acid, (Aceto-Salicylate) - - Grs. XV Iodine, (Iodate) Equivalent to Iodide Potass Grs. XV Acetic Acid, (Acetate) Equiv. to Acetate Potass Grs. V Aconite - Equiv. Tr. Aconite R. Gtts. IV Bryonia 4* •' Tr. Bryonia, Gtts. V Colchicum - " " Vin. Colchicum R.Gtts. XV Capsicum - " " Tr. Capsicum Gtts. II Oil Gaultheria " " 4< - - HI । This formula being indefinite and vague, the examination of saliodin was taken up in the Association laboratory. From the analysis we calculate the composition of saliodin to be approximately equivalent to a mixture of: Sodium salicylate 57.54 Potassium iodid 1.18 Potassium acetate 30.00 Matter volatile at 130° (oil of anise, oil of gaul- theria, moisture, etc.) 8.10 Undetermined (extractive?) 3.18 100.00 The analysis shows that the formula is not only indefinite and vague, but incorrect and false. To emphasize the incorrectness of the published formula the following comment on the first two items is offered: In the "formula" it is stated that 20 grains of saliodin contain approximately "salicylic acid (aceto-salicylate) Grs. XV." The statement is not clear, but conveys the impression that 20 grains of saliodin contain an amount of an aceto- salicylate, a salt of acetyl-salicylic acid (aspirin), equivalent to 15 grains of salicylic acid. But the chemical examination shows that it contains neither acetyl-salicylic acid, or salt of acetyl-salicylic acid, nor even salicylic acid itself. In the 126 PROPAGANDA FOP REFORM place of these, the analysis shows that over half of saliodin is the common, every-day sodium salicylate. According to the "formula," each 20 grains of saliodin contains "iodin (iodate), equivalent to iodid potass. Grs. XV." This statement, too, is vague, but conveys the impression that 20 grains of saliodin contain an amount of iodin, in combina- tion as an iodate, which corresponds in iodin content to 15 grains of potassium iodid. But the analysis shows that the product does not contain any iodate whatever, and that the amount of iodin contained in it is sufficient to account for only grain of potassium iodid in each 20 grains of saliodin. COMMENTS The above report is published simply as another example of the "ethical proprietaries" that physicians are asked to prescribe. It is not unique. It is neither better nor worse than hundreds of others. It is an "lodated, Aceto-Salicylate with Adjuvants," and the SPECIFIC treatment for every form of URIC ACID DIATHESIS. "Saliodin" is a SOL- VENT and ELIMINANT of URIC ACID and is a happy combination of Salicylic Acid, Iodine, Acetic Acid, Aconite, Bryonia, Colchicum, Capsicum and Gaultheria and chemically appears in the form of a PINK, GREYISH POWDER soluable in water 1 to- 3-dose grs. X to grs. XXX; for the EX- CLUSIVE USE OF PHYSICIANS-put up in one ounce bottles; price PER OUNCE $1.50. Is manufactured ONLY by the Saliodin Chemical Co. "^AL- IODIN is SPECIFICALLY indicated in RHEUMATISM, GOUT NEU- RALGIA, MALARIA and LA GRIPPE; is ANALGESIC, ANTIPYRET- IC; an INTESTINAL ANTISEPTIC, DIAPHORETIC, DIURETIC, EX- PECTORANT, DEOBSTRUENT, SIALAGOGUE, CHOLAGOGUE, EM- MENAGOGUE, ANTI-SYPHILITIC, GONOCOCOCIDAL, PARASITICL DAL, ASEPTIC, BACTERICIDAL and ALTERATIVE. Doctor, you may prescribe Saliodin with confidence wherever IODINE or a SALICY- LATE is indicated. Used both internally and externally. Reproduction (much reduced) of a paragraph in the advertising pamphlet on Saliodin. Note the twenty-one indications for Saliodin. Lest some condition might be overlooked, we are advised to use it "internally and externally." Isn't this scientific therapy? To show what absurdities appear in the "literature" (?) that is sent to physicians, we reproduce a paragraph from an advertising pamphlet. The promoters' statement as to the composition of the product is absurd, but not more so than are the claims made for it as a therapeutic agent. There is not a "patent medicine" on the market for which any more blatant, extravagant and ridiculous claims are made. The manner of exploiting saliodin is another illustration of the tendency on the part of nostrum-makers to advertise LA BORA TOR F CONTRIBUTIONS 127 their wares through pseudo-scientific articles published in a certain class of medical journals. In the pamphlet sent out by the Saliodin company appears a reprint of an article from the Philadelphia Medical Summary of February, 1905. It is entitled "A Similarity in the Etiologic Factors of Rheumatism and Malaria," and was written by J. C. Denston, M.D. In it occurs this statement: "The manufacturers (of saliodin) publish their formula and, I think, distribute samples and literature on request." The charming ingenuousness of this statement is fully realized when it is understood that J. C. Denston is the president of the Saliodin company. This is also another illustration of what is now a common occurrence, viz.: men who are engaged in manufacturing proprietary products and who have an M.D. degree use that degree as a commercial asset, and by this means the average reader is led to think that articles written by them in praise of their own products are spontaneous tributes from practicing phy- sicians.-(From The Journal A. M. A., Oct. 26, 1907.) EXAMINATION OF TABLETS OF BISMUTH, OPIUM AND PHENOL W. A. Puckner and A. H. Clark CONTRIBUTION NO. 1 The demand for "palatable and convenient" medicaments has led manufacturing pharmacists to attempt to produce in tablet form mixtures which, from the nature of the case, are not suited to that method of compounding. In such cases it becomes a question as to what reliance the physician may place in such products, and so an examination of a type of these preparations was made in the Association's laboratory. Nearly every manufacturing pharmacist lists in his cat- alogue a tablet composed of bismuth, opium and phenol (car- bolic acid). According to the price lists and labels, each tab- let contains either five or three grains of bismuth subnitrate, one grain of aromatic powder, one-half grain of powdered opium and one-half grain (in one case one-eighth grain) of phenol. Specimens of different makes of this tablet were purchased, in open market and from the manufacturer, and were exam- ined to determine the amount of phenol each contained. A long series of experiments, the details of which will be pub- lished elsewhere, were carried out to determine the best method of estimating the amount of phenol in mixtures of this nature. 128 PROPAGANDA FOP REFORM The results here tabulated were obtained from the exami- nation of specimens purchased direct from the manufac- turer. At least one other specimen-bought in the open market-of each manufacturer was examined, the latter giving in nearly every instance a lower figure, probably because it had been in stock longer. In the few cases in which the latter specimen gave a higher result, both findings are given. The essential point brought out by the table is, of course, that shown by the figures in Column 3-"Amount Found Ex- pressed as-Per Cent, of Amount Claimed." It should be real- ized that if the tablets contained the amount of phenol ©4-0 o g2 c 2 Mm T! C C w C A 5 Manufacturer. © ° 2 - o o o- ~ • 2 c & +-> 5 ~ ? a ~ .4 o o ~ g a u o 1 2 3 Hance Bros, and White 8.45 1.85 21.89 W. S. Merrell Chemical Co 6.30 3.08 48.89 H. K. Mulford & Co 1.72 .90 52.34 Parke, Davis & Co (No. 1) 6.08 70.23 Parke, Davis & Co. (No. 2) 5.87 2.74 47.02 Sharp & Dohme (No. 1) 8.41 6.11 72.65 Sharp & Dohme (No. 2) 8.23 2.85 34.63 Frederick Stearns & Co 7.27 1.93 26.55 Truax, Greene & Co 10.03 1.36 13.69 II. K. Wampole & Co. (No. 1). .. . 9.19 4.24 46.14 H. K. Wampole & Co. (No. 2) . . . . 8.98 3.49 39.31 Wm. R. Warner & Co 12.08 1.53 12.66 1. These figures were obtained by dividing the difference in weight of the heaviest and lightest tablet by the average weight and multiplying this quotient by one hundred. 2. The figures given here are obtained by dividing the highest per cent, of phenol found by the per cent, of phenol indicated by the formula on the package and multiplying this quotient by one hundred. claimed, the numbers in this column would all be 100. But instead of this even the best specimen contained only 76.25 per cent., while some ranged as low as 12.66 per cent. These tablets are a typical illustration of the attempts to produce, in "elegant and palatable form," the impossible-im- possible at least without care and expense. From the nature of the processes involved in the manufacture of a tablet, it is very difficult to produce one containing a definite amount of a volatile substance like carbolic acid. Accuracy in dosage is indispensable to the scientific administration of drugs. In LABORATORY CONTRIBUTIONS 129 medicinal preparations of the type just described the essential -accuracy-is sacrificed for the merely desirable-convenience and palatability. To the extent to which physicians prescribe, as tablets, combination of drugs that cannot be successfully put up in that form, to that extent does scientific medicine suffer.-(Modified from The Journal A. M. A., July 25, 1908.) W. A. Puckner and W. S. Hilpert CONTHIBUTION NO. 2 More than two years ago the examination of tablets of bismuth, opium and phenol was taken up in the Association laboratory to determine the reliability of pharmaceutical preparations of complex formulas, more or less difficult to prepare. The result of this examination, published in The Journal, July 25, 1908,■ p. 330, showed that the tablets sold by different firms contained amounts of phenol ranging from 72.65 per cent, down to 12.66 per cent, of the amount the tablets were claimed to contain. In discussing this discrepancy three questions may be asked: 1. Are these supposedly reputable firms deliberately selling these products below standard? 2. Are these firms unable to determine the quality of their product? 3. Do these firms merely neglect to deter- mine the composition of the finished product? In other words, are these firms dishonest, incompetent or merely negligent? Considering the standing of the firms named in the report, one would hesitate to say that these discrepancies were due either to dishonesty or to incompetence and would be inclined to take the more charitable view of negligence. Two years having elapsed and the report of the laboratory having been given the widest publicity, it would seem that if these firms were ignorant of the real composition of theii product at the time the examination was made and published, they would by this time have had ample opportunity to correct the matter, and either to have brought the products up to the claim or else to have discontinued their sale. To determine whether the discrepancies pointed out in the report referred to could be ascribed to ignorance and whether the firms had made any effort to improve the quality of the products, specimens of these tablets as sold by each of the firms concerned in the first report were again purchased from one of the large wholesale drug houses and their phenol content again determined.* The following table gives the result of this examination: * For method of analysis see "Method B," in the annual report for 1908 of the Chemical Laboratory of the American Medical Asso- ciation. 130 PROPAGANDA FOR REFORM p W. R. Warner & H. K. Wampole & Co Truax, Greene & Co Q p co S 8= GO1? O s 0 <3 Ui Q p g p Hh o d i Q o 72 CD S' 2 s W 6 p s C n CD CD 2 S Ui o u: o . F . B • CD • to 73 o r1 co cd HL p co <33 io 4- O1 _ * ! . Per cent, phenol 00 73 co -1 M 00 to o Cl CO > according to to co o r1 co ci -X 70 formula on la- hoi 1 -; b C< b b -'I 3, __i Hl uei. ci o CO o r* CO M co Hl HL 03 o CO Hi co Cl b CO *o -L . 33- j' CO CO C3 co M • 73 Cl Per cent, phenol found. -L 4^ to -L 4^ IO -L 3 3 to co H. -1 co -I b Cl o CO 00 Hl CO CO f-1 H*- 'CO 4^ 73 co 0 HL co Hl to -1 -1 Ct 4^ IO Hl IO co co 33 to o to CO -- b co o ci b io c< co co 73 CO 73 CO Amount found > expressed as to co to co to co Ct 4^ W CD s Ct co per cent, of amt. claimed.2 to b -L co b L < Ct H1 -q Ct co CO 03 CO CO CO Percentage of_ variati 0 n + + 1 1 M IO + + + (plus or mi- nus) between o 4< 4^ co co co H-1 00 to 1908 and 1910 co co b 4^ o co co 03 O 3 co findings. 1. These figures were calculated from the claimed phenol-con- tent of each tablet and the average weight of the tablets found. 2. These figures were calculated from the percentage of phenol claimed (Column 1) and the percentage found (Column 2). From the above results it is seen that at the present time the phenol-content of the tablet now ranges from a maximum of 63.53 per cent, down to a minimum of 12.27 per cent, of that claimed on the label. The products of some of the firms have improved somewhat, while the products of others are worse than they were two years ago. On the whole, it seems that many of the firms still sell these products with- out being greatly concerned as to their composition. But one firm, whose product contains nearly two-thirds (%) of the amount of phenol claimed, the H. K. Mulford Co., appears to have considered the past report. The trade package now bears the following legend: "The aniount of phenol in this tablet on account of its volatile nature is approximate." It would seem, then, that, of the three alternatives suggested, the one ascribing this discrepancy to negligence must be dis- carded and the profession must decide whether it is to be attributed to incompetence or dishonesty. [Editorial Note:-The findings of the Association chemists are not creditable to the pharmaceutical manufacturers con- cerned. The question asked is a serious one. Regarding at LABORA TO R Y CONTRIBUTIONS 131 least most of the firms the charge of incompetence would hardly hold, since they employ chemists who are men of standing and are known to be entirely competent to control the manufacture of their products. To say that these firms are dishonest in the matter is a serious charge and no one will believe for a moment that they deliberately used a defi- cient amount of drug for the sake of saving a few paltry cents in the manufacture of these tablets. We would be inclined to take the view that these firms have little respect for physicians who use such complex mixtures; that, though- producing, as a general rule, reliable and honest medicines they believe that in the case of products such as these, scien- tific accuracy is a waste of time. Perhaps they are right. At least, this should serve as a lesson to physicians who are inclined to use complex, ready-made formulas of this kind and persuade them to write individual prescriptions whose correct compounding by competent pharmacists may be depended on.]-(From The Journal A. M. A., Dec. 17, 1910.) W. A. Puckner and W. S. Hilpert CONTRIBUTION NO. 3 Nearly three years ago, a contribution from the Chemical Laboratory appeared in The Journal, dealing with the com- position of tablets of bismuth, opium and phenol (carbolic acid). It was there shown that these tablets contained only from 72.65 per cent, down to as low as 12.66 per cent, of the amount of phenol stated on the label. After publishing these results in detail and waiting a little more than two years, we again examined similar tablets of the same makes, bought in the open market. The results of this second examination were published in The Journal, Dec. 17, 1910. Instead of finding that conditions were better, that the firms had made an effort to market tablets that were true to the label, this examination showed that the phenol- content of the tablets now ranged from 63.53 per cent, down to 12.27 per cent, of the amount claimed. This second examination also showed that the manufacturers were not sufficiently concerned with the quality of their product to call in any stock which they must have known was untruthfully labeled. In view of this fact, it was thought worth while both to learn the ages of the various tablets that were purchased at the time of, and for the purpose of, making the second examination and also to examine the most recently 132 PROPAGANDA POU REFORM made tablets put out by the same firms. Accordingly, the identifying marks on each package of tablets examined and which formed the basis of the report of the second paper, were sent to the respective firms with inquiries as to the date of the manufacture of these various specimens. At the same time orders were placed in each case for the firm's most recently made product. The result of this work is arranged in tabulated form as follows: Table 1 gives the age of the specimens that were used for the second examination; Table 2 compares the com- position of tablets as found in the rirst and second examina- tions with the composition found in the present (third) examination. TABLE 1.-AGE OF TABLETS IN SECOND EXAMINATION Manufacturer Date of Manufacture Date of Purchase Age When Purchased Hance Bros. & White.. . Sept. 17, 1910. Oct. 27, '10 1 month. W. S. Merrell Chem. Co. July 11, 1900.. Oct. 27, '10 4 years. II. K. Mulford Co Nov. 22. 1909.. Sept. 15, '10 1 year. Parke, Davis & Co Sept., 1910. . . . Sept. 15, '10 Under 1 mo. Sharp & Dohme June 1, 1906... Sept. 15, '10 4 years. F. Stearns & Co August, 1906. . Oct. 27, '10 4 years. Truax, Greene & Co.. . . Prior to 1906.. Sept. 16, TO 4-5 years. H. K. Wampole & Co.. . Aug. or Dec.,'08 Oct. 27, TO 2 years. W. R. Warner & Co.. .. Aug. 3, 1906... Nov. 11, TO 4 years. taiSle 2.-composition of tablets in first, second AND THIRD EXAMINATIONS Phenol Found Expressed as Per Cent, of Amount Claimed Specimen Purchased Specimen Obtained Manufacturer on Market from Manufacturer A 1908 1910 1910 Hance Bros. & White. . . . 21.89 34.19 34.49 W. S. Merrell Chem. Co.. 48.8!) 57.59 68.43 II. K. Mulford Co. ..... . 52.34 63.53 83.18 Parke, Davis & Co ) (a) 70.23 • ) (b)47.02 46.86 46.83 Sharp & Dohme J (a) 72.65 • 1(b) 34.63 53.39 38.14 F. Stearns & Co 26.55 23.17 24.86 Truax, Greene & Co 13.6!) 28.09 28.24 H. K. Wampole & Co. . .. J(a)46.14 • ((b) 39.31 53.75 112.64 W. R. Warner & Co 12.66 12.27 41.47 Strange as it may seem, some of the manufacturers wrote as if they had not known of the former publication of the laboratory's examination. Wm. R. Warner & Co. writes that it is going to engage the services of a commercial chemist to examine the stock LABORATORY CONTRIBUTIONS 133 and that it will not offer the tablets for sale until assurance is had that the tablets are true to claim. While it may cause some surprise to learn that this firm must engage outside talent to learn the quality of its own wares, the decision to discontinue the sale of its practically worthless stock is to be commended. Il § Ugg's ii gs^ || o2^g ST! 0 7? dO o a o a ? o a ? m gS g 0 § & s = Name of Firm orti : of 1. orti : of in pui ■ket orti : of in pui ■ket '-Bo-ags k p oun imec k p ounl md lets mai k p ounl nd lets mai nS«"Su M o 0 g o o gag gas^c gsok a K a O K 8 _ du rt o d'w-p o MM M M Hance Bros. & White • e e o W. S. Merrell Chem. Co... • e e H. K. Mulford Co • e $ 9 Parke, Davis & Co • ® Sharp & Dohme • e F. Stearns & Co • O £ Truax, Greene & Co • e © H. K. Wampole & Co e e e W. R. Warner & Co • e e The above presents the findings of the Association chemists in a graphic form and shows the great discrepancies between the claims made for the tablets and the actnal facts. The solid black portions represent the phenol-content. In the first column is given the phenol content claimed by the manufacturer; in the second column is shown the actual phenol-content found in the tablets purchased in 1908 ; the third column represents the phenol-content as found in the tablets purchased on the market in 1910, while the fourth column shows the phenol-content of the tablets purchased in 1910 direct from the manufacturer. Note ths excess of phenol in the tablets sent by II. K. Wampole & Co. in filling the order for a bottle of the most recently made products. (From The Journal A. M. A., May 6, 1911.) 134 PROPAGANDA FOR REFORM The tablets which were obtained direct from H. K. Wampole & Co. and which were found to contain an amount of phenol in excess of the amount claimed were quite different in appearance when received from any previously examined in that they were damp and had a strong odor of phenol. About two months later, the tablets of this batch which remained in the bottle presented a most remarkable appearance in that they were covered with an efflorescence of crystals of phenol. Should these tablets be dispensed on a physician's prescrip- tion the possibilities are that the pure phenol would come in direct contact with the tongue and throat and produce painful burns. Of course these tablets are quite unfit for use. Another important matter brought out is the fact that ready-made mixtures, such as these_ tablets, may be four or five years old before they leave the hands of the wholesaler. While, in this case, the efficiency of the remedy is not influ- enced by age, it is a well-known fact that many drugs rapidly deteriorate. If tablets such as these are likely to be four or five years old before they leave the wholesale house, how old will they be before they are dispensed on a physician's pre- scription ? This question is a pertinent one and the answer- which the laboratory's work furnishes-should do much to discourage the prescribing of such ready-made mixtures. UNGUENTINE W. A. Puckner and A. H. Clark Attention has been called at various times to the fact that the value of a published "formula" to a proprietary remedy is in direct ratio to the reliability of the manufacturer pub- lishing it. When medical journals first insisted on their ad- vertisers letting physicians know the contents of the reme- dies they wished to sell them, medical literature reeked with formulas-some of them of weird and wonderful design. Since the advent of the Food and Drugs Act, which requires that labels shall approximate truthfulness, and particularly since the Council on Pharmacy and Chemistry has investi- gated a number of proprietary remedies, the publication of "formulas" is not so common. Unguentine, manufactured by the Norwich Pharmacal Co., is one of those remedies whose advertisement for years always included "a formula"; more recently, however, this is not in evidence. In an advertisement which appeared about ten years ago, the "formula" given is: LA BORATORY CONTRIBUTIONS 135 "Carbolic acid 2 per cent. "Ichthyol 5 per cent. "Alum 15 to 16 per cent." It was claimed that by a special process of their own, the manufacturers had eliminated most of the astringent proper- ties of the alum rendering it non-irritant. It was also stated that "the base of Unguentine is pure petrolatum." Later the manufacturers seem to have changed the composi- tion of their product, or at least the "formula" given in the advertisements was changed. Thus it appeared: "Alum 15 per cent. "Zinc oxid 5 per cent. "Carbolic acid 2 per cent. "Ichthyol 5 per cent. "Aromatics and antiseptic oils with specially prepared petrolatum and. animal fat base." The introduction of zinc oxid, aromatic and antiseptic oils and animal fat was a new feature. Somewhat later, and par- ticularly since the passage of the national Food and Drugs Act, no formula or other statement in regard to the compo- sition seems to have appeared in the advertisements in the medical press. In the 1906 price list (p. 170) the following formula appears: "Unguentine represents : "Alum (non-irritating) ;15 per cent. "Phenol 2 ner cent. "Ichthyol 5 per cent. "Zinc oxid 5 per cent. "Aromatic and antiseptic oils, with especially prepared petrolatum and purified animal fat." In the price-list issued for 1908-after the Food and Drugs Act went into effect-the following appears: "Unguentine represents: "Alum compound (non irritating) "Phenol, "Ichthyol, "Zinc oxid, "Aromatic and antiseptic oils, with especially prepared petrolatum and purified animal fat." Thus the proportions are omitted, and alum becomes "alum compound," whatever that may mean. In view of the conflicting statements made by the Norwich Pharmacal Company, in regard to their leading specialty, Unguentine, and especially because much stress was laid on the filing of their "guarantee" under the Food and Drugs Act, it was decided to ascertain of what Unguentine really consists. 136 PROPAGANDA FOR REFORM From our analysis we conclude that Unguentine contains not alum but aluminum acetate (small amounts of alum may be present as impurities in the aluminum acetate), zinc oxid, or more probably impure zinc carbonate, and that the entire quantity of both does not exceed 5 per cent. It contains no ichthyol, or if any but the merest traces, and less than 1 per cent, of phenol. The aromatic oils amount to not more than approximately 1 per cent, in all. The ointment-base is, in the main, petrolatum. In Unguentine we have, therefore, another proprietary "specialty," regarding the composition of which indefinite, false or misleading statements have been made-this irrespective of protestation of honesty by the firm.-(From The Journal A. M. A., March 27, 1909.) URICEDIN W. A. Puckner and A. H. Clark In view of the results of investigations by Zernik of Uricedin as sold in Germany, and because it is being adver- tised to physicians in this country, an examination of this product was made in the laboratory of the American Medical Association. Zernik's report shows how this remedy has varied in its composition as put on the market in Germany. From their analysis the authors find that uricedin is not a definite chemical compound as is claimed, but is a simple mixture whose composition is approximately: Sodium sulphate (anhydrous) 61.52 per cent. Sodium citrate (anhydrous) 29.62 per cent. Sodium chlorid 2.13 per cent. Citric acid (anhydrous) 3.25 per cent. Moisture 2.53 per cent. Undetermined 0.95 per cent. 100.00 Uricedin, therefore, is not a definite chemical compound as claimed, but a simple mixture which consists essentially of sodium sulphate (dried Glauber salt) %, and sodium citrate y3. It is, therefore, a typical nostrum, and, as it appears, one the composition of which is changed from time to time to suit the whim of the manufacturer. The thera- peutic claims made for it are of the usual extravagant char- acter. According to a recent advertisement it is "used success- fully for Gouty Diathesis, Urinary Calculi, Rheumatoid Arthritis," "useful in Migraine, Occipital Headache, Epilepsy, Hay Fever, Asthma," etc. If such a simple mixture will do all that this one is claimed to do, let us use it, but prescribe LABOR A. TO RY CONTRIBUTIONS 137 its ingredients under their proper names. Such a mixture would cost only a few cents a pound, but this nostrum is listed at $1.25 a bottle of five ounces, or probably $1.75 at retail, and this for the benefit of its foreign manufacturers and their agents.-(Abstracted from The Journal A. M. A., Nov. 23, 1907, 1788.) URISEPTIN W. A. Puckner and W. S. Hilpert "Uriseptin," manufactured by the Gardner-Barada Chemical. Co. of Chicago and claimed to be a "urinary antiseptic, uric acid solvent and diuretic," was examined in the laboratory of the American Medical Association to determine to what extent the claims made for it are justified. The preparation as purchased in the open market bears a label which presents the claims of the manufacturers, empha- sized by the chemical analysis duly signed by an analyst and attested by a notary. Accompanying is a reproduction of part of the label. Before the examination had extended very far it was found that discrepancies existed between facts and claims, and by the time the analysis was complete Uriseptin was found to be in the same class as many other proprietary remedies that have been discussed in these columns. Our examination shows that the most misleading statement is that concerning the "lithium-formaldehyd" compound the presence of which is claimed, more or less directly, by both the manufacturers and the analyst employed by the manufactur- ers. Although the chemical properties of lithium and formal- dehyd indicate in themselves that the existence of such a compound would be most improbable, yet considerable time was spent in searching the chemical literature for such a compound. Thorough search, however, demonstrated that no such compound, nor any that even approximated it, has been described. The question then arose as to the form in which the lithium and the formaldehyd are present. The statements regarding its properties as a urinary antiseptic and the fact that the preparation is said to slowly liberate formaldehyd in the bladder point strongly to the presence of hexamethylenamin. Tests1 were applied to demonstrate whether the formaldehyd was present as a lithium compound, and if not, whether 1. These appear in the annual report for 1908 of the Chemical Laboratory of the American Medical Association ; they were also published in full in Jour. Am. Chem. Soc., September. 1908 ; an outline of the analysis appeared in The Journal A, M, A., Aug. 29, 1908. 138 PROPAGANDA FOR REFORM it existed in the form of hexamethylenamin. By these the presence of hexamethylenamin was proved and the absence of formaldehyd in other combinations demonstrated. This fact alone shows that the preparation is deliberately marketed under a false claim, and it shows further that the analysis on the label is worthless. The quantitative method of analysis demonstrated the presence of 5.51 gm. hexamethylenamin per 100 c.c. (25.15 gr. per fluidounce). Rcduced photographic reproduction of part of the Uriseptin label. Besides the hexamethylenamin, Uriseptin contains lithium and a benzoate. Concerning the latter nothing is said in the analysis, whose worthlessness is again demonstrated. By quantitative methods Uriseptin was found to contain lithium and a benzoate in such proportions as would indicate that the lithium and the benzoate radicle exist as lithium benzoate. This fact is further indicated by the claims made for the preparation regarding its properties as a uric acid solvent, for which purpose lithium benzoate is often used. Again, the demonstration that the formaldehyd present is in combination as hexamethylenamin precluded any possible chemical com- LA BORA TORY CORT RIB UTI0 RS 139 bination between lithium and formaldehyd and adds another strong point in support of the conclusion that the lithium and benzoic acid are in combination as lithium benzoate. CONCLUSION By chemical analysis the active ingredients of Uriseptin are shown to be hexamethylenamin, approximately 5.5 gm. per 100 c.c. (about 25 gr. to each fluid ounce), and lithium benzoate, approximately 0.70 gm. per 100 c.c. (about 11 gr. to each fluid ounce), neither of which compounds is mentioned in the adver- tising matter on the label or in the so-called "analysis" on the label. The statements concerning the composition of Uri- septin are false and appear to be a deliberate attempt to mislead physicians. Comment.-Investigation of the various "patent" and so- called "ethical proprietaries" advertised to the public and to the medical profession shows that those that have any value as therapeutic agents depend for that value on some well- known drug or drugs. Hence, while many proprietaries have some virtue, the ingredients which are of any value are so concealed by the coined and "near-scientific" names applied to them that these drugs are usually unrecognizable. The many and various acetanilid mixtures furnish examples of this class of proprietaries. And now we find another example in that much advertised nostrum, Uriseptin. According to our chemists, the chief ingredients of Uriseptin are hexamethylenamin and lithium benzoate. Hexamethyl- enamin is a valuable so-called urinary antiseptic-probably one of the best we have. It is a pity that more physicians do not know the value of this drug in and of itself; it is a common ingredient of many proprietaries, and yet too seldom prescribed under its true name. There is no reason for its being given in the form of a nostrum; it requires no skill in compounding, for it is best given in its powdered-form, either in capsules or otherwise. So that, like acetanilid, the old argument of the nostrum men that the preparation needs skill in compounding will not hold. If a physician wants to prescribe hexamethylenamin let him prescribe it in its simplest and best form, and thus know exactly what he is giving. Lithium benzoate also has its rightful place in the materia medica, but not hidden in a proprietary mixture to be pre- scribed unknowingly. It is hard to conceive of any one thing that operates more disastrously against scientific therapeutics 140 PROPAGANDA FOR REFORM than the vicious practice of marketing under proprietary names standard and valuable drugs, with their identity pur- posely concealed. Yet how frequently it is done. Well-known drugs of unquestioned worth are combined with those that are little known and of doubtful value, or more likely abso- lutely worthless, the mixture is put on the market under a high-sounding name and it is exploited through physicians as a panacea for all kinds of diseases. In this, as in so many other instances, an "analysis" made to order is given to lend an air of apparent respectability and scientific standing to the preparation or to its exploiters, with the object, of course, of misleading physicians into thinking they are reading unbiased testimony. In addition, the "litera- ture" accompanying the preparation is usually a jargon of pseudo-scientific verbiage put in to serve the same purpose as the analysis-that of catching the careless physician. This state of affairs will continue just so long as the medical profession will tolerate it-and no longer. So long as members of our profession will prescribe proprietaries on the statements of their owners-both as to their composition and therapeutic value-just so long will pseudochemical and pseudopharmaceutical companies fatten at the expense of the medical profession and to the detriment of the public health. -(From The Journal A. M. A., Aug. 29, .1098.) ZEMACOL W. A. Puckner and W. S. Hilpert Attention has been called to the vague and mysterious statements regarding a preparation called Zemacol, manufac- tured by the Norwich Pharmacal Co., Norwich, N. Y. Because of the unsatisfactory statements regarding the composition of the preparation, it was considered of sufficient interest to make an analysis and determine its chemical constituents. Accordingly specimens of the preparation were obtained and examined. The preparation Zemacol (Norwich Pharmacal Co.), as found on the market, is a thick, pink, mucilaginous liquid, highly perfumed and having besides a suggestion of a phenolic odor. The bottle bears a label on which appear the following statements: "A colloidal emollient containing extract of the rete mucosum of the healthy yearling lamb, combined with glycerin, salicylic acid and other antiseptic and aromatic oils. Useful in eczema and diseases of the integument where cell destruction is a prominent factor." LABORA TOR Y CO NTRIBUTIO NS 141 In the advertising matter the following claims are made: "An advance in animal therapy. . . ." " . . increases the nutritive activity of the cell tissue of the skin through the absorbable extract of the rete mucosum." " . . clinical tests show its efficacy in both the so-called moist and dry eczematous conditions of all parts of the cutaneous surfaces." " rich in animal cells." Since nothing could be found in the literature regarding the therapeutic action of an extract of the rete mucosum of the sheep, it was thought possible that the statements on the label were given simply as a vague and mysterious means of indicating the presence of wool-fat (lanolin)and tests were made to determine the presence or absence of the latter sub- stance. A substance was isolated from Zemacol which had the physical properties of, and responded to some of the chemical tests for, wool-fat-but it was found in such small quantities as to indicate that it was not present as an active constituent. Since there are no definite tests for the detection of serums or animal extracts the presence or absence of these could not be demonstrated. Further examination indicated the presence of salicylic acid, a gummy material, having the properties of tragacanth and glycerin. It is practically free from inorganic matter. By distillation a small quantity of oil was isolated, which possesses the characteristic odor of the preparation. Quantitative estimations1 indicated the presence of the above-mentioned constituents in approximately the following quantities: Per Cent. Gummy matter having the properties of tragacanth.. 2.02 Salicylic acid 0.67 Matter having the general properties of wool-fat (lanolin) . 0.20 Glycerin ■ 5.50 Volatile matter (water and alcohol) . 91.00 Aromatic oils and phenol-like bodies Trace The results of the above analysis, together with advertising matter regarding Zemacol. were submitted to Dr. William Allen Pusey, professor of dermatology and clinical dermatol- ogy, College of Physicians and Surgeons, Chicago, and past chairman of the Section on Dermatology of the American Medical Association, with the inquiry whether or not there was any record of investigations regarding the therapeutic value of an extract of the rete mucosum of the sheep and whether in his opinion the claims made for Zemacol would be warranted. The following reply was received: 1. The details of the analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Associa- tion. 142 PROPAGANDA FOR REFORM "So far as I know, nobody ever thought of or proposed the use of an extract of rete mucosum as a therapeutic agent and if a serious suggestion of that sort had ever been made I believe I would know it. I can conceive of no service which such an extract could render and I think the suggestion of it is a highly fantastic idea. From the analysis which you fur- nish I should say that the mixture described is substantially the ordinary 2 per cent, solution of tragacanth in glycerin and water with a little antiseptic added to keep it from decom- posing. That is a commonly known lotion, modifications of which are used in practically every hospital as a hand lotion, and has no magical virtues whatever. Incidentally, I should think it cost, aside from the labor, about twenty cents a gallon to make it."-(From The Journal A. M. A., May U/, 1910.) ZYME-OID W. A. Puckner and W. S. Hilpert Zyme-oid, manufactured by the Oxychlorine Chemical Com- pany of Chicago, is advertised as "a powerful gastro-intestinal antiferment" which will "arrest and prevent bacterial fer- mentation in any portion of the intestinal tract, whether the media be acid or alkaline." These extravagant statements, like many others made regarding the properties of zyme-oid, are very similar in character to those made in the circulars accompanying the preparation oxychlorine, manufactured by the same firm and exposed in The Journal, July 6, 1907, page 54. (See page 66 of this book.) As examples, several parallel statements help to show this similarity. The formula ( ?) of oxychlorine, as expounded on the label, is given in full, while in the case of zyme-oid only a hint is given as to its composition, but still sufficient to point to a similarity between the two: OXYCHLORINE "Oxychlorine is a tetrabor- ate of sodium and potassium combined with oxychlorid of boron, thus: (GNaKBiOj) BOC13." ZYME-OID "Zyme-oid is a double bor- ate salt." In the matter of claims for chemical stability the two seem to be very closely allied: Oxychlorine is ''a stable salt under all conditions until brought in contact with sub- oxygenated organic matter." Zyme-oid is "a product which is stable enough for keeping purposes, but which readily yields nascent oxygen in the presence of bacterial products." LA BORATORY CONTRIBUTIONS 143 The therapeutic properties attributed to these sister prod- ucts are even more similar, for we find that: "Oxychlorine is adapted to all morbid and abnormal fer- mentative alimentary states." "Zyme-oid is a powerful gastrointestinal antiferment." Many more statements and claims could be quoted to show a similarity between, amounting almost to an identity of, oxy chlorine and zyme-oid. With these facts in mind, the analysis of zyme-oid was undertaken in order to compare it with the previously exam- ined oxychlorine and to determine to what extent the claims made for zyme-oid are upheld by its composition. The anal- ysis indicated, as was expected, that zyme-oid is essentially the same as oxychlorine as is shown in the following, quoted from the report of the analysis of each: ANALYSIS OF OXYCHLORINE Potassium (K) 12.26 Sodium (Na) 8.20 Chlorate (C1O3) 25.32 Nitrate (NO3) 21.70 Boric acid anhydrid (B2O3) 18.63 Water, calculated 13.29 ANALYSIS OF ZYME-OID Potassium (K) 13.50 Sodium (Na) 9.84 Chlorate (C1O3) 27.50 Nitrate (NOS) 24.22 Boric acid anhydrid (B2O3) 13.42 Water, calculated 10.42 Assuming that the chlorate in zyme-oid is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by analysis correspond to a mix- ture approximately as follows: Potassium chlorate (KC1O3) 40.43 Sodium Nitrate (NaNO3) ... 33.22 Potassium tetraborate (K2B4O7) 1.60 Sodium tetraborate (Na2B4O7) 3.31 Boric acid 21.14 From the results of the analysis and from the physical properties of zyme-oid we conclude, just as was done in the case of oxychlorine, that the preparation is not a definite chemical compound, but is essentially a mixture of alkali chlorate and nitrate with boric acid, probably produced by fusing together the constituents. COMMENT An examination of the claims made for the firm's two prod- ucts, while, as already proved, disclosing many points of similarity, will also show one remarkable difference. We refer to the skilful indefiniteness that pervades the claims made for zyme-oid and which defies scientific refutation. This verbal obscurity is becoming daily more common in the 144 propaganda for reform "literature" of firms marketing nostrums. Since the Council has analyzed many of the much-advertised articles and proved the unreliability of the pseudo-scientific claims made for them, the more cautious of the nostrum-mongers have modified the matter descriptive of their products. They have called to their aid the principle that words were given to man to conceal thought rather than to express it, and they have reduced equivocation to a fine art. Wherever it was possible to put forward claims by implication rather than by expression this has been done. To substantiate further the claims made by the manufac- turers of zyme-oid for their product, a laboratory report is brought in evidence. This report, which is written more in the style of a peruna testimonial than that of a conservative scientific statement, fails to verify the claim that zyme-oid is a "double borate salt," but confines itself to a statement of its harmlessness and its antr-fermentative properties. In pass- ing, it seems regrettable that scientific laboratories should, for a pecuniary consideration, be willing to jeopardize their repu- tations by lending their names to the furtherance of nostrum exploitation. The results of the examination of zyme-oid demonstrate that the product is no more worthy of the physi- cian's consideration than its close, and equally worthless, rela- tive, oxychlorine.-(From The Journal A. M.A., May 23,1908.) PART III MISCELLANEOUS NOSTRUMS ALLEOTONE The formula of this preparation, given in the literature, reads as follows: Alcoholic! (Monatomic) . gr. 1/1000 Quinine Sulphatis gr. 1/384 Ac. Sulph. Dil. (10 per cent.) gtt. 2% Ac. Nitrici Dil. (10 per cent.) gtt. 1/77 Ac. Butanol-Dioic gr. 1/3 Tr. Ferri Chloridi gtt. 1/26 Aquae gtt. xx The formula is worthless. It can only mislead and mystify. Here and there, it is true, flashes of truth appear, but the greater part of the literature is a mere jumble of inaccurate and mystifying statements. The various constituents of the preparation are taken up as follows: The advertising litera- ture states that "Monatomic Alcohol is one of the constituents of all nerve tissue: It is a product of the replacement of one atom of hydrogen of the hydrocarbons by their hydroxyl group H.O." This information does not inform, since there is a vast number of monatomic alcohols and of every description. The assertion that the preparation "contains a salt" would be perfectly analogous and just as enlightening. Of "Ferri Ohio" the literature says: "Ferri Ohio is found with all proteids and nucleins and herein acts as magnetic iron, aiding the play of the electrical travel." The first assertion is untrue, for iron does not exist as chlorid in the cells of the body, but as some organic iron compound; neither is it found in all proteids,-but principally in nucleoalbumins; and all proteids do not contain nucleoalbumins. The assertion that the iron chlorid "acts as magnetic iron aiding the play of the electrical travel" is non- sensical and on a par with the electrical belt method of exploitation, and suggests forcibly the class to which Alleo- tone belongs. The literature further states: "Sulphuric and nitric acids act in removing hydrogen atoms and substitute atoms of the radical NO2; that is, as hydrogen tranquilizes the speed of burning or oxidation, its action is substituted by the atom nitrogen which is energy itself, nitrogen being the base 146 PROPAGANDA FOR REFORM of all explosives." Sulphuric acid is certainly an oxidizing agent and in virtue thereof removes hydrogen; but not in a solution whose concentration with respect to sulphuric acid is approximately only 0.82 per cent. The statement that nitrogen is the "base of all explosives" is another example of the methods of the promoters. As it is a well-known fact, how- ever, that nitrogen itself is one of the least reactive of gaseous elements, little confidence can be placed in such remarks as "Nitrogen which is energy itself." Another mystifying term used in the formula is "Ac. Butanol-Dioic," which is a true chemical name, certainly, but it is one by which few physi- cians will recognize simple malic acid, an ordinary vegetable acid widely distributed in ripe fruits, such as apples and pears, and possessing the properties simply of a relatively weak organic acid. To describe it as exercising any potent influence "in the oxidation of the phosphorus as lecithin in the cell"-especially in the extremely low concentration in which it is stated to exist in Alleotone-is simply an absurd juggling with words. It is not much to be wondered at that the public should be taken in by pseudoscientific "literature;" but it is not only strange, it is discreditable to our profession, that among its members should be found any to accept such rubbish as the above quoted "literature" as information worth acting on-yet such there are, judging from the testimonials. -(Abstracted from The Journal fl. M. A., Feb. 1, 1908, p. 379.) The Commercial Value of Adverse Criticism For skilful attempts to convert a "knock" into a "boost," commend to us the discredited nostrum exploiter. The fed- eral Food and Drugs Act did much to bring out this amiable quality-possibly developed it. While somewhat ancient his- tory, it is well to call to mind what happened when the excise authorities insisted either that the "patent medicine" booze, Peruna, have some medicine put in it, or else that its manu- facturers should go into the saloon business. Hartman at once got out a new label stating that "for a number of years a multitude of grateful friends" had urged "that Peruna be given a slight laxative quality." Thenceforth the innocents and near-innocents could get their perunaese jag only at the risk of a "bad quarter of an hour." One of the latest attempts to wriggle out of an uncomfort- able position, and at the same time make capital out of the wriggling, is seen in the advertising of Alleotone, a nostrum of the pseudoscientific type, which was shown up in The Journal of Feb. 1, 1908. The "formula" furnished is for MISCELLANEOUS NOSTRUMS 147 the most part a jargon of misleading and mystifying non- sense and fulfils the same purpose as the voluble "patter" of the gentleman who is manipulating three shells and a pea at the county fair. Every constituent of the "formula" was discussed in The Journal and the absurdities and impossibilities of each dwelt on. Did the manufacturers of Alleotone feel downeast over the exposure of their humbug? Not to judge by their.adver- tising, for they write to physicians that "since the A. M. A. analyzed Alleotone it has made great strides"-direction not specified. But the choicest piece of impudence, and one that but for its dishonesty would be laughable, is found in this portion of their advertising pamphlet: In the original, the words "With amendments suggested in the Journal of the American Medical Association, Feb. 1, 1908," and also "(Cholesterin.)" and "(Malic Acid.)," which we have underscored in the illustration, are printed in red and have been added to the original "formula." Such are the uses of adversity. What claim, if any, the exploiter of this nostrum-B. F. Copeland-has to medical or pharmaceutical knowledge, we do not know. In fact, to be consistent with the "ethics" of the nostrum business he need have none. Such knowledge, indeed, tends to hamper that free play of the imagination so neces- sary in this work. We understand that he has at different 148 PROPAGANDA FOR REFORM times been in charge of a stave factory and connected with a brokerage firm, which may exert some subtle influence in developing the ability to relieve suffering humanity, though the connection is not quite clear. One would imagine, how- ever, that the keen business instinct, untrammeled by any considerations of conscience, which is exhibited in the exploita- tion of Alleotone, would in purely commercial pursuits have long since assured a competence.-(From The Journal A. M. A., Oct. 17, 1908.) ANTIKAMNIA The Nostrum and Its Method of Exploitation Our readers will be interested to learn some of the remark- able properties which, according to the statements of the manufacturers, this Antikamnia possesses. We quote from the advertising literature: The well-known nerve specialist (?), Dr. Harley, in an interview published in the London Daily Express, says: "I have treated more than one American for nervousness and 'brain fag' directly due to their incessant energy. I had a young man in here this morning who complained of headache 'in the back of the neck.' He was threatened with congestion of the brain, and seemed somewhat aggrieved when I told him he had been trying to do too much. I also treated a young American woman who, since her arrival in London, had apparently been living on Antikamnia tablets by the advice of her physician. It was the only thing, she said, which kept her 'braced up' for the strain of sight-seeing." (Why did the young woman consult this Dr. Harley-for the drug habit?) Note the following: For the severe pains or rheumatism, dysmenorrhea, neuralgia, gout, sciatica and lumbago, as well as for the lightning pains of locomotor ataxia, there can be no quicker and more lasting relief obtained than by the administration of Antikamnia and codeine tablets. Imagine an intelligent physician trying to treat the diseases mentioned below with the various impotent means of the pharmacopeia and physiological therapy when he might depend on Antikamnia! We quote again: As a Pain Reliever.-In headache, cephalalgia, hemicrania, migraine [some other words might have been thrown in so as still more to emphasize the headache business], myalgia, coryza, la grippe and its sequalae, the lightning pains of locomotor ataxia and all pains due to irregular menstruation. As an Anodyne or Sedative.-In alcoholic delirium, indigestion, cardialgia, gastralgia, dyspepsia, hysteria, insomnia, inebriety, car- sickness, sea-sickness, worry and sight-seer's fatigue. MISCELLANEO US NOSTRUMS 149 As an Antipyretic.-In typhoid, intermittent, puerperal and malarial fevers, bronchitis, pneumonia, pleurisy, and tuberculosis. As an Anti-Neuralgic.-In acute or chronic neuralgia, facial neuralgia, earache, pain about the teeth, angina pectoris, neuras- thenia, palpitation, pains of locomotor ataxia and sciatica. As an Anti-Rheumatic.-In acute or chronic rheumatism and gout, fever and pleurodynia. There is no remedy so useful and attended with such satisfactory results as Antikamnia tablets in the treatment of melancholia with vasomotor disturbances, anemic headaches, emotional distress, and active delusions of apprehension and distrust. They increase arterial tension and promote digestion, as well as being particularly serv- iceable in relieving the persistent headache which accompanies nervousness. In neurasthenia, in mild hysteroid affections, and in the various neuralgias, particularly ovarian, and in the nervous tremor so often seen in confirmed drunkards, they are of peculiar service. In angina pectoris this drug has a beneficial action ; it relieves the pain and distress in many cases, even when amyl nitrite and nitro- glycerin have failed entirely. In pseudo-angina, frequently observed in hysterical women, its action is all that can be desired. Patients who suffer from irritable, weak, or palpitating heart, needing at times a pain reliever, can take Antikamnia tablets, without untoward after-effects, knowing that the heart is being fortified. In delirium tremens, they relieve when there are great restlessness, insomnia, the general lowering of the nerve power. Only the vivid picture of a crisis in locomotor ataxia or the agony of a true migraine, can impress the observer with the full value of this pain reliever. The following testimonials are from physicians: Dr. Caleb Lyon, an old Bellevue practitioner, in referring to antikamnia and codein tablets, says: In my practice they accompany the maid from her virgin couch to her lying-in chamber, assuaging the perplexities of maidenhood and easing the trials of maternity with most gratifying results. I earnestly hope that the proprietors of this valuable remedial agent will keep it up to its present standard of purity and excellence. Dr. Walter M. Fleming, A.M., M.D., New York City, writes: . . . With all the experience of more than a quarter of a century, in the treatment of winter cough, and all its complications of laryngeal, bronchial and pulmonary irritability, dyspnea, asth- matic spasms, and finally whooping cough-usually the most per- sistent and tenacious of all these membranous maladies-I find no one remedy more strongly indicated, or which yields more prompt and satisfactory results than Antikamnia and heroin tablets, com- posed of Antikamnia 5 grains and heroin hydrochloride 1/12 grain. . . . Result: a prompt and efficient expectorant, at once relaxing the harsh and rasping cough, releasing the tenacious, sticky and gelatinous mucus which is soon readily expectorated, while the soothing influence of the Antikamnia is at once manifested, greatly to the comfort and contentment of the patient. . . . Independ- ent of the fact of the direct applicability of this remedy to the various membranous maladies of the lungs, bronchi, fauces and nose, 150 PROPAGANDA FOR REFORM it proves also, an invariable remedy in all febrile cases where anodyne is required. This, together with its analgesic and anti- pyretic merits, eminently qualify this combination for a responsive agent in the treatment of nearly all the numerous febrile attacks characterized by pain, nervousness, insomnia and their accom- panying symptoms. "Antikamnia and Quinin" If there is any virtue in the particular combination known as "Antikamnia," a physician prescribing the tablets supposed to contain combinations of "Antikamnia" and some other drugs should have some guarantee that they contain those remedies. Take, for example, the tablets advertised and sold, as "Antikamnia and quinin." It might reasonably be sup- posed that the tablets contained the combination known as "Antikamnia"; this, however, seems not to be the case. Previous analyses, as published1 by us, have shown that Anti- kamnia contains approximately 20 per cent, of sodium bicar- bonate, yet two chemists, working separately, have been unable to find this ingredient in the tablets advertised and sold as "Antikamnia and quinin." Are we to understand, there- fore, that the manufacturers do not consider the bicarbonate of sodium of importance in their preparation, Antikamnia; or are they guilty of misrepresentation and of misleading physi- cians in omitting this constituent from their product Anti- kamnia when that is combined with the bisulphate of quinin? The above statement regarding the omission of bicarbonate of sodium from the quinin combination may be verified by any physician who desires to make a few simple chemical tests- carbonic acid is not given off when the tablets are treated with dilute acids, as would be the case if sodium bicarbonate were present. Further, while the ordinary Antikamnia contains no constituent not soluble either in water or in chloroform, and while quinin bisulphate is readily soluble in water, the tablets said to contain Antikamnia and quinin bisulphate, when treated successively with water and with chloroform, leave a residue of more than 18 per cent. One of the chemists who analyzed the preparation for us, in commenting on this in a letter, says: "The matter which is insoluble in water, alcohol or in chloroform, i. e., the substance which is neither 'Antikamnia' nor quinin bisulphate, amounts to more than 18 per cent, in 'Antikamnia and quinin bisul- phate tablets.' The tablets weigh close to five grains and are said to contain 2.5 grains each of Antikamnia and quinin 1. The Journal, A. M. A., June 3, 1905; reproduced on page 9 of this edition. MISCELLANEOUS NOSTRUMS 151 bisulphate. How is this possible when each tablet contains almost one grain of foreign substance (chiefly starch) ?" Further comment is superfluous. We have presented facts to our readers and leave them to draw their own conclusions. -(From The Journal A. M. A., July 1, 1905, p. 55.) Adding Insult to Injury When the Council on Pharmacy and Chemistry, nearly two years ago, began its work of independent and scientific inves- tigation of proprietary preparations, some of the questions asked were: 'What guarantee has the medical profession that the for- mulas of these proprietary medicines are not changed at the will of the manufacturers? How can the physician who con- fidingly prescribes them for his patients know that the prepa- ration which he orders to-day is the same as that which was furnished him last year, or which may be given him next year, under the same name?" At once a wail, as of injured innocence, went up from countless venders of proprietary medicines, who replied with one voice: "The honor and reputation of the proprietors and manufac- turers is sufficient guarantee of the stability and permanence of these preparations." So vehement were their protestations and so well simulated were their declarations of Pecksnifiian virtue that many physi- cians were deceived thereby. Many medical journals (whose views were, perhaps, slightly biased by the consideration of fat advertising contracts) also were apparently convinced. But the fact was overlooked that guarantees based on honor are of value only in proportion to the amount and quality of honor possessed by the guarantors. The enactment of the national Food and Drugs Act is bring- ing many things to light. Some of them are interesting, some would be amusing were they not so Utterly despicable. Among other things, it has furnished a demonstration of the value of the "honorable assurances" of nostrum venders. The nostrum Antikamnia has pointed many a moral in the campaign in the last two years. It was hardly to be hoped that it would deliberately furnish a demonstration of the utter lack of honesty on the part of a certain class of proprie- tary manufacturers. Yet, relying apparently on the ignorance of the public and the long-continued lethargy of the medical profession, its promoters have, in the last few weeks, unwit- 152 PROPAGANDA FOR REFORM tingly convicted and stultified themselves. When the pure food law went into effect, the proprietors of this mixture found themselves in a sad dilemma; if they labeled their mixture in accordance with the provisions of the law they would have to admit that it contained acetanilid and that the charges against them were true. Failing to comply with the law, they must go out of business. The latter alternative was not to be thought of. The profits gained by selling, with the aid of careless or ignorant physicians, a five- or ten-cent mixture for $1 were too great to be surrendered without a struggle. The same brilliant intellect, perhaps, that first saw the com- mercial possibilities in the business, said: "Change the for- mula. Phenacetin is about as cheap as acetanilid; the patent has just expired and consequently we can get it at a low price. Let us substitute phenacetin for acetanilid." As a result the profession is treated to an edifying exhibi- tion of virtue triumphant, a wolf so completely covered by the harmless coat of a sheep that he flatters himself that his wolfish nature is completely concealed. No longer are skulls and skeletons sent out in calendar form as grinning advance agents to be displayed in every doctor's office, but instead a beautiful domestic scene, showing a convalescent child nestling in the arms of its mother. The familiar "AK," however, as usual, is in the lower right-hand corner. And what a change in labels! No longer is Antikamnia a chemical entity, but the label now openly but ingenuously declares that "Antikamnia tablets in this original package contain 350 grains of acet- phenetidin, U. S. P., per ounce. Guaranteed under the Food and Drugs Act, June 30, 1906. Serial No. 10." While, below, as an entirely unnecessary display of conformity to the Pure Food Act, appears this statement: The Antikamnia tablets in this original ounce package contain no acetanilid, antifebrin, antipyrin, alcohol, morphin, opium, codein. heroin, cocain, alpha- or beta-eucain, arsenic, strychnin, chloroform, cannabis indica or chloral hydrate. Truly, Satan is appearing as an angel of light. What a gratification it is to the long exploited profession to know that Antikamnia contains no alcohol, no chloroform, no* cannabis indica, no chloral hydrate. How unfortunate that this spon- taneous display of confidence is not carried far enough to inform the profession of the ingredients, aside from phenace- tin, contained in the mixture! The label is an admission that the nostrum does not contain what it was never supposed to contain, with the exception of acetanilid, and is directly an attempt to conceal the real MISCELLANEOUS NOSTRUMS 153 contents. The proprietors know that the dear public, whose "pains, headaches, neuralgias, women's aches and ills, grippal neuroses, nervousness, insomnia, rheumatism, lightning pains of locomotor ataxia, sciatica, etc.," they are longing to assuage, will not know that acetphenetidin is the official designation for what is popularly known as phenacetin, and that this A reduced reproduction of a full-page Antikamnia advertise- ment appearing in the New York World Almanac. 1911. The Anti- kamnia concern does comparatively little advertising direct to the public, except by means of circular letters and samples. It relies on physicians acting as unpaid pedlers of its nostrum. dangerous product is found in the new mixture in the propor- tion of approximately 4 grains to a 5-grain tablet. Evidently they also presume considerably on the ignorance of our pro- fession, or why should they make the brazen statement that 154 PROPAGANDA FOR REFORM four grains of phenacetin is the "most reliable remedy" for the long list of diseases enumerated on their advertising calendar ? When the formula for which such wonderful virtues were claimed was suddenly thrown overboard, was the medical pro- fession, which by its short-sighted patronage had built up this business, notified in any way of the change? Search the new advertising matter of this nostrum from beginning to end and you will not find one word to show that "The Antikamnia tablets in this original ounce package" differ in the slightest particular from those sold to the profession and the public for years past. This being true (and the statements of the pro- moters themselves are our authority for it), what remains of the pratings of "honor" and the "guarantee of the manu- facturers"? Has a physician no right to know when a change is made in the formula of a preparation which he has been prescribing for years? WTiat assurance has the profession that, at any moment, a cheaper or more dangerous drug may not be substituted for "acetphenetidin" if thereby the law can be evaded or the profits of the delectable business enhanced? How can any conscientious physician prescribe, for those who confide their lives to his care, a preparation the stability of the formula of which must depend absolutely on its owner's whim ? How can a physician with the slightest sense of responsi- bility to his patients allow his office to be used as a free advertising bureau for a preparation manifestly founded and developed on deceit and misrepresentation ? How can any medical journal, except those avowedly and unblushingly seeking to aid the nostrum maker to exploit the profession, whose interests they claim to serve, continue to carry the deceptive and misleading advertisement of a twice exposed fraud? How can any physician with a particle of self-respect or manhood continue to support, by subscription or contribution, any medical journal which, by accepting such advertising, allies itself with the army of deceit and chicanery?-(Ab- stracted from The Journal A. M. A., Jan. 26, 1901, p. 31/0.) Still Further Duplicity When the Food and Drugs Act went into effect the manu- facturers of this preparation, instead of continuing to put out the same mixture as they had been doing radically changed the composition by substituting acetphenetidin (phenacetin) MISCELLANEOUS NOSTRUMS 155 for acetanilid. By doing this the company avoided the dis- agreeable necessity for acknowledging on the label that the nostrum contained acetanilid, as was shown by the analysis published in The Journal, June 3, 1905. In addition to stating that the package of Antikamnia contained acetphene- tidin, the company also stated that it contained no "acetanilid, antifebrin, antipyrin, alcohol, morphin, opium, codein, heroin, cocain, strychnin, chloroform, cannabis indica, or chloral hydrate." Knowing that the nostrum is being advertised in Great Britain and Canada as well as in the United States, The Journal obtained some Antikamnia from London, and it was analyzed in the Association's laboratory. As was sus- pected, the analysis showed that Antikamnia as sold abroad has the same composition now as it had in the United States before the Food and Drugs Act went into force, viz.: Acetani- lid, 67.75 per cent.; caffein, 4.88 per cent., and citric acid and sodium bicarbonate, by difference, 25.36 per cent. This corre- sponds with the analysis previously made and published in The Journal, June 3, 1905. The Antikamnia on the market in this country was also analyzed and it was found to contain: acetphenetidin (phenacetin), 72.05 per cent.; caffein, 13.95 per cent.; citric acid and sodium bicarbonate, 14 per cent. The preparation sold as "Antikamnia and Quinin" was also ana- lyzed, and it was found that starch had been substituted for the bicarbonate of sodium which is found in the Antikamnia itself. The details of the analyses are given with the follow- ing comments: "The above are brief statements of bald facts. Two of these should be emphasized: (1) When the Food and Drugs Act went into force, January, 1907, the manufacturers of Antikamnia, rather than acknowledge the truth of the past -we can imagine no other reason-materially and radically changed the composition of their preparation, and did this without notifying the medical profession or intimating in any way, so far as we can learn, that such a change had been made. We have no doubt they believed they had a right to do as they pleased with their own; that it was nobody's business but theirs what they did with their own preparation, or how they changed it. As they never had told physicians what it con- tained, there was no reason why they should do so now. This is logical, and we cannot blame the manufacturers so long as the medical profession is willing to be humbugged. (2) For the same reason, we presume, they claim that they have a right to continue to use acetanilid in the product for the for- eign market. The Food and Drugs Act applies only to the 156 PROPAGANDA FOR REFORM United States, of course, and acetanilid being cheaper, why not use it? What is the difference if one is more dangerous than the other? The fact that the Antikamnia sold abroad differs from that sold in this country some may say is of no special interest to us. Still this fact is worth noting: The dose of acetphenetidin-phenacetin-(7% grains) is nearly double that of acetanilid (4 grains) : one becoming accustomed to a certain dosage of the nostrum as sold in this country might, while abroad, unwittingly be led to take a double dose of acetanilid.-(Abstracted from The Journal A. M. A., Feb. 8, 1908, p. 1/67.) Samples, Form Letters and "Prescriptions" Sent to the Laity To the Editor:-The enclosed "literature" is being sent broadcast to the laity by the Antikamnia people and still a great many of the physicians throughout the country are pre- scribing the preparation thus advertised. Will the time ever come when the medical fraternity will awaken to the fact that it has been humbugged by a great many manufacturing com cerns ? I certainly hope so. J. W. DuVal, M.D., Wichita Falls, Texas. Comment:-The "literature" referred to by our correspond- ent consists of a form letter and a small pamphlet. The letter reads as follows: Dear Mr.-- : Do you ever suffer pain? If so. try Antikamnia Tablets: Sample enclosed. Your druggist will supply them in any quan- tity (10 cents worth or more), also in our regular "Vest-Pocket Boxes." Sincerely yours, The Antikamnia Chemical Company. The pamphlet accompanying the letter is entitled "Practical Prescriptions," and contains a list of diseases and morbid states arranged alphabetically from "Alcoholism," "Asthma" and "Backache" to "Wind," "Women's Pains" and "Worry." For the one hundred and twenty-two conditions listed, "Anti- kamnia," "Antikamnia and Codein" or "Laxative Antikamnia and Quinin" are prescribed, demonstrating that the "prescrip- tions" are more "practical" than scientific. In many respects the methods of the proprietors of "head- ache powders" and "anti-pain pills" are less offensive to one's sense of professional decency that the course pursued by the Antikamnia people. The former have at least never recom- mended their products as "ethical proprietaries;" they have MISCELLANEOUS NOSTRUMS 157 not used medical men as their unpaid agents; the claims made for their products have been no more exaggerated; and they have not found it necessary, from the requirements of the Food and Drugs Act, to substitute acetphenetidin for acetan- ilid to avoid giving the lie to their former claims. As to the query propounded by our correspondent: We are optimistic enough to believe that the time he longs for is already here. The fact that the proprietors of nostrums of the Antikamnia type are finding it necessary to advertise to the laity is, in itself, evidence of the diminishing demand for such products on the part of the medical profession.-(From The Journal A. M. A., April 18, 1908, p. 1281.) ASPIRO-LITHINE Aspiro-lithine is another comparatively new example of the custom of proprietary manufacturers in putting forward old drugs under a new name and with them bidding for the favor of physicians. An inquiry has been received concerning this mixture. It is prepared by McKesson & Robbins and is said to contain in each tablet 5 grains of acetylsalicylic acid (aspirin) and 2% grains of acid citro-tartrate of lithium. It is recommended for all the purposes for which acetylsalicylic acid is commonly used, and on account of the lithium added is claimed to have much greater virtues than eithei' of these drugs alone or of both combined. We had hoped that the time had passed for reputable houses to employ such time-worn methods, but probably they will not stop so long as physicians encourage them by continuing to use such preparations. Acetylsalicylic acid is a good drug, whose value is pretty well known. It is further known that lithium salts do not possess any great medicinal virtue. Just what acid citro-tartrate of lithium may be is hard to tell, for chemistries do not recognize such a substance. The name presumably is intended to hide the real nature of the prepara- tion. But if there be any advantage in combining lithium salts with acetylsalicylic acid in a prescription, it is a simple propo- sition and requires no great skill, either on the part of the physician who writes the prescription or on the part of the druggist who puts it up, and such mixtures as aspiro-lithine, with the exaggerated claims made for them, should be avoided in the physician's prescribing.-(From The Journal A. M. A., May 28, 1910.) 158 PROPAGANDA FOR REFORM BENETOL During the last few months sensational and ridiculously misleading articles have appeared in the daily press regarding a proprietary preparation called Benetol. The nostrum seems to be advertised by the direct method only to physicians; to the public it goes via the special newspaper article route, as a "marvelous medical discovery." It is but fair to say in this connection, that the newspapers which have published these articles seem to have done so in good faith and in total ignorance of the fact that they were giving the Benetol Com- pany a large amount of free advertising. It is evident that the press agent's work was well done. Here are a few claims that are made, either to the medical profession or to the public, for Benetol: "A new germicidal antiseptic marvel." "The only safe germicidal antiseptic." "It will cure any germ trouble it can reach." "Is beneficial rather than dangerous in overdoses." "The only germicide that can follow and kill germs." "A laboratory product of the University of Minnesota." "A chemical which destroys the germs of tuberculosis, typhoid and cancer." "Ten drops allowed to remain a short time in a gallon of infected water will make the water not only safe to drink, but will make it beneficial as a medicated water." In the newspaper write-ups on Benetol, its discoverer is given about the same degree of publicity as the drug. Benetol is said to have been "discovered" by "Prof. H. C. Carel, Head of the Department of Medical Chemistry and Toxicology, University of Minnesota (Retired)." In many of the newspaper articles it is Implied that Carel is still a member of the faculty of the University of Minnesota. The facts are, Carel has not been connected with this institu- tion for some years. His connection with the university ceased at the time he exploited a hair restorer-"Hygenol." In selling his cure for baldness, he attempted then, as he is attempting now, to make capital out of the good name of the university-and the board of regents saw to it that Carel's connection with the university was severed. The attempt, therefore, to exploit Benetol as "a laboratory product of the University of Minnesota," is both an outrage on an institution of learning and a fraud on the purchaser. In one of the press-agent notices on Benetol, the claim is made that tne War Department has investigated Carel's "New Discovery" and that the heads of the department have urged MI SCELLA NEO US NO STR UMS 159 the government to secure the "sole information and owner- ship" of Benetol. As a clincher it goes on to say: "An emissary is being sent/ to Prof. Carel to enter into negotia- tions, and for the first time in its history the United States gov- ernment may go into the germicide business." Greatly reduced photographic reproduction of a part of a full- page newspaper write-up of Benetol. Under the portrait of the "inventor" of Benetol appears the statement "Prof. Herbert Charles von Fuerstenburg Carel, of the University of Minnesota, the in- ventor of Benetol." This write-up appeared in the Philadelphia North American, a paper that treats "patent medicine" fakers with scant courtesy. It was the appearance of such an article in a paper of this type that caused us to investigate the method by which the exploiters of Benetol got their product into the newspa- pers in this form. An inquiry at the War Department, regarding the veracity of the statements given in the exploitation of Benetol, brought the following statement from the office of the surgeon-general: "As you have surmised, there is no foundation of truth in the statement which you inclose with reference to the use of 'Benetol' by the medical department of the Army. This office has not author- 160 PROPAGANDA FOR REFORM ized the purchase of any 'Benetol' nor has it investigated its merits." Nor was the army alone the only department of the govern- ment that was credited with waxing enthusiastic over Carel's nostrum. It was claimed that the stuff had been tested in the navy. An inquiry addressed to the Bureau of Medicine and Surgery of the Department of the Navy brought the following statement: "This Bureau has never issued 'Benetol' for use in the Navy and does not contemplate doing so, having no knowledge of, nor interest in, this preparation," In view of the claims that have been made for Benetol its composition is a matter of interest. What is this marvelous germicide; this "chemical," which destroys the germ of cancer; this wonderful discovery which "for six years Prof. Carel toiled night and day" to produce; this potent typhoid destroyer, 10 drops of which in a gallon of infected water' will make the water not only safe but beneficial; what is this new medical wonder? This inquiry was referred to the director of the Association's Chemical Laboratory and secre- tary of the Council on Pharmacy and Chemistry, who replied: "Chemical examination of Benetol shows that it is a solution of alpha-naphtol containing about 18 gm. of the substance in 100 c.c. The solvent appears to consist of water, glycerin and soap. Alpha-naphtol is a well-known substance, closely related to, but not identical with, beta-naphtol which is official in the United States Pharmacopeia. The claim made in the adver- tising matter for Benetol, that it is a newly discovered com- pound, is absurd. It is not a chemical compound but a simple solution of the well-known substance alpha-naphtol in the still better-known substances, glycerin, soap and water."-(From The Journal A. M. A., April 15, 1911.) BROMIDIA Deaths From the Use of the Remedy- Dr. Horatio C. Wood, Jr., Philadelphia, writes: "One of the deleterious results of using proprietary mixtures even when the formula is known is that the physician gets in the habit of thinking of the mixture as a remedial entity, instead of a combination of active ingredients, and is thereby led to use this combination in cases in which he would have avoided the individual drugs making up the mixture. The fol- lowing item is taken from the Philadelphia Evening Telegraph, MISCELLANEOUS NOSTRUMS 161 February 13, and also appeared in several New York papers; it preaches an eloquent but pathetic sermon on this subject: Within an hour after his father, a Brooklyn physician, had given him a dose of bromid, H. G. P., a prodigal son, died yesterday at his father's home in Brooklyn. Two years ago, when he appeared to have sown his wild oats, the father made him superintendent of his country place, near Grants Mills, Delaware County. A week ago the son left his place, and at 1 o'clock yesterday morning appeared at his father's Brooklyn home. He was nervous, and at 9 a. m. begged for a sedative. "I prescribed the usual quantity of bromidia," the young man's father told a reporter. "He was weak and had suffered from weak heart and kidney trouble for some time." An hour later the father found the son dying and administered restoratives, but to no avail. "In an article published in The Journal, June 10, 1905, page 1836, I quoted in regard to bromidia the remarkable statement of the manufacturers that it is "the safest hypnotic known," and questioned how the addition of potassium bromid and tincture of hyoscyamus could overcome the depressant action of the chloral, which is the active ingredient of this nostrum. If the physician had thought of his bromidia as a solution of chloral rather than as a solution of bromid he probably would have hesitated before using it in an alcoholic case." The following appeared in the Bangor (Me.) Commercial, March 8: Frank H. Perkins, a newspaper reporter of Plymouth, Mass. was found dead in a room in a hotel in Augusta, Sunday. The coroner stated that death was due to bromidia poisoning, but whether the drug was taken accidentally or with suicidal intent is a matter of conjecture. Perkins was a newspaper correspondent in Plymouth for 22 years. He left a few weeks ago to accept a position on the city desk of the Kennebec Journal. While a resident of Plymouth, he was correspondent for a number of Boston papers, and in recent years was connected with the Plymouth Observer. lie was 55 years old and unmarried. It is understood that his nearest surviving relative is an aunt in Middleboro. The above item was sent to Dr. 0. C. S. Davies, Augusta, with a request that he send us a more complete report of the case. In his reply Dr. Davies stated that Mr. Perkins had at one time been an inmate of an inebriates' home and that he had gone to Augusta to do newspaper work, but had been unable to hold the position because of his condition. Dr. Davies in his letter, says: "When the body was found, there were eleven one-ounce bromidia bottles about the room or on his person. Nine were entirely empty and the other two were about half full. None of these bottles indicated that they had been purchased on a physician's prescription, only the drug- 162 PROPAGANDA FOR REFORM gist's label marked 'bromidia' being on them."-(From The Journal A. M. A., April 21, 1906, p. 1221.) BROMIN-IODIN COMPOUND The Life-History of a Nostrum A correspondent writes for information concerning a remedy known as Bromin-iodin Comp., which he says is manufactured by the Bromin-Iodin Chemical Company, formerly of Bing- hamton, N. Y., but now located in San Diego, California. In The Journal for Feb. 5, 1898, appeared an article by Dr. C. W. Ingraham, Binghamton, N. Y., entitled "Five Years' Successful Experience with a Special Mode of Treating Pul- monary Tuberculosis." This "special mode" of treatment con- sisted -in using what Dr. Ingraham called "bromin-iodin com- pound," which he said had the following formula: lodin gr. 1/2 Bromin gr. 1/14 Phosphorus gr. 1/100 Thymol gr. 2/3 Menthol gr. 2/3 Sterilized oil fl. dr. 1 This "hypodermic treatment of phthisis" was widely adver- tised in the late nineties by the Bromin-iodin Chemical Co., Binghamton, N. Y., and was but one of the innumerable "treatments" for pulmonary tuberculosis that have risen, had their day and, more or less gracefully, retired. It was first sold "to physicians only" for- hypodermic administration. In 1906, however, physicians were told by the company that "if we find it impossible to secure your cooperation . . . we will be compelled to do business with the druggists in your local- ity. " Apparently they found such cooperation impos- sible, because a leaflet was issued to the laity and the state- ment was made that they intended to advertise "all over North America in publications of national and international circulation, as well as in local newspapers. . . ." Naturally the laity couldn't be expected to administer this treatment by the hypodermic method and it is not surprising to read that "experiment has proved that the same solution can be taken internally." In addition to the advertising leaflet, the public also was provided with a "pocket calendar good for 200 years" which contained numerous testimonials from physicians laudatory of the "bromin-iodin" treatment. The layman who received one of the leaflets was told that if he was suffering from "asthma, bronchitis, colds, consumption, coughs, eczema, MISCELLANEOUS NOSTRUMS 163 goiter, hay fever, neuralgia, rheumatism . . . also constipation and kidney troubles," and his recovery was "not as rapid as it should be," should, moreover, his physician refuse to use the bromin-iodin compound "it might not be a bad idea to discharge him" and get a physician who would! At the time this "treatment" was first tried by its "in- ventor," the results given in fifty cases were: First stage, 90 per cent, cures; second stage, 50 per cent, cures; third stage, no cures, but improvement in several cases; this was in 1895. It now appears that this "treatment" has after a period of "patent medicine" exploitation come back into the "ethical proprietary" field. Presumably a mixture such as that rep- resented by the "formula" did not lend itself to administra- tion by mouth; there was nothing to do, therefore, but enlist the aid of "easy" physicians in furthering its sale.-(From The -Journal A. M. A., June 4, 1910.) BUFFALO LITHIA WATER It Is Now an "Alkaline Diuretic" Chicago, Aug. 10, 1908. To the Editor:-A few weeks ago the representative of the Buffalo Lithia Water called on me at my office. In discussing the merits of the water, I called his attention to the fact that it contained merely a trace of lithium. He replied that they made no claim for it as a lithia water, but sold it as an alkaline water which the physician might prescribe as he saw fit. He said that the name was selected simply to distinguish it from the host of other mineral waters. If my memory serves me correctly, this constitutes a remarkable change of front on the part of the promoters of this widely advertised mineral water. Not long ago it was highly vaunted as a uric acid element depending on its content of lithium for its therapeutic action. Doubtless many physicians during the last twenty years have prescribed gallons of this water, some- times for patients who could ill afford to pay for it, on the supposition that it contained lithium, and was, therefore, a valuable remedy against uric acid. What is the reason for the abandonment of this claim on the part of the proprietors? Is it because, following closely the advance of medical science as they must, they have learned that lithium is no longer regarded as a uric acid eliminant ? Or have they learned for the first time from the government analyses that their water contains practically no lithium? The claim that the water is 164 PROPAGANDA FOR REFORM an alkaline water is no better supported by facts than that it is a lithia water. This also they can learn from the govern- ment report if they will read it carefully. The alkaline theory will doubtless serve its purpose until attention is called to the fact that it is a calcic saline water. It will be interesting then to learn what quality will next be invoked to sell it. It seems as if it is time that physicians should awake to an appreciation of the need of caution in accepting the claims of those who have mineral waters to sell. There is as much need for supervision here as in the case of proprietaries. Comment:-Were it not for the tragic element it would be ludicrous to note the way in which manufacturers and pro- prietors of medicinal agents adjust themselves to varying con- ditions. Adaptation to environment is the essential element for success. This is illustrated by the facts brought out by our correspondent in the above letter. When Buffalo Lithia Water was first put on the market uric acid was the scapegoat on Which most of the sins of etiologic ignorance were heaped. Contemporaneous with, and in a sense a corollary of, the uric acid fallacy was another hypothesis, viz., that lithium was the uric acid eliminant par excellence. The proposition, therefore, was a simple one: Uric acid causes disease; lithium eliminates uric acid; ergo, Buffalo Lithia Water, because it contains lithia, eliminates disease. Q. E. D. The result of these two theories, combined with skilful advertising on the part of the proprietors, made Buffalo Lithia Water a valuable piece of property. "The mills of the gods grind slowly," but finally government and other chemists, with small appreciation of the psychic and commercial value of the name, demonstrated that Buffalo Lithia Water con- tains but the merest trace of lithium-an amount almost as small as the gold in a widely advertised liquor cure. Now, therefore, it is an "alkaline diuretic." While govern- ment analysts dispute the claim that it is an alkaline water, yet its proprietors may rest assured that the statement regarding its diuretic properties is beyond contradiction, for water of any kind is the simplest, surest and most universal of diuretics. It may be noted in passing that the more recent advertisements refer to Buffalo Lithia Springs Water instead of Buffalo Lithia Water. This is a distinction with a differ- ence and the change in title has probably been brought about by that great agency for comparative righteousness in adver- tising-the national Food and Drugs Act!-(From The Jour- nal A. M. A., Sept. 12, 1908.) MISCELL A FEO US NOSTRUMS 165 CALMINE New Names for Old Drugs "Calmine, the new Hypnotic," is another example of the ingenuity of the exploiters of proprietary preparations in coining new names for old drugs and the recklessness with which exploiters herald forth .renamed remedies to the pro- fession and the public as new and wonderful discoveries. This is what the promoters, sustained by a calm confidence in the credulity of the profession; have to say: In the piedical circles throughout the country a good deal of interest and even enthusiasm over this new hypnotic is noticeable. Very few drug products have attracted so much attention as this one. A really satisfactory hypnotic and sleep-inducer, which Calmine certainly seems to be, has been awaited expectantly for many years. Of course, we have always had agents of this sort-a new one has come out at frequent intervals-but none of them have "filled the bill" ; they have been prescribed only because there was nothing better to be had. Now this new and wonderful discovery is nothing but Ver- onal-sodium (sodium diethyl-barbiturate) under another name. It is the sodium salt of the more or less favorably known hypnotic, Veronal (diethyl-barbituric acid). It is also sold as Medinal, and differs from Veronal only in that the combina- tion with sodium has made it more readibly soluble, and thus, it is claimed, its absorption is more prompt. Veronal is pro- tected abroad by a trade-mark and in this country by a patent, and this, undoubtedly, is responsible for the introduction of this sodium salt under these fanciful names, because Veronal could not be sold without infringing on the patent. This in turn induced the manufacturers of Veronal, in self-protection, also to put the sodium salt on the market, and now we have it under the name of Calmine. This probably is only the beginning; soon we may look foi' it Under a host of other names and the usual result will follow: thoughtless physicians who have had poor results with it under one name will try it under others. Or worse still, physicians will thoughtlessly combine Veronal with Calmine or with Medinal in the same prescription, thus giving a dangerous dose.-(From The Jour- nal A. M. A., Jan. 11), 1011.) 166 PROPAGANDA FOR REFORM CAMPHENOL Camphenol is made by Johnson & Johnson, New Brunswick, N. J. Under the name of the article on the earton appears the following formula: C10H10O-C0H4(CH3) OH=C0HBOH. This formula consists of the chemical formulas for camphor, cresol and phenol, written one after another, and from this one would conclude that Camphenol is a compound of camphor, phenol and cresol in molecular proportions. Examination shows, however, that Camphenol is but a modification of the well- known camphorated phenol (the liquid produced when solid camphor and phenol are triturated together). In Camphenol a part of the phenol, in the camphorated phenol, has been replaced by cresol, and this liquid has been diluted and emul- sified With gelatin or some similar substance and perfumed. In other words, this preparation is an emulsion containing relatively small quantities of cresol, phenol and camphor and is another illustration of the attempts of would-be pharma- ceutical houses to produce new synthetics in the simplest manner possible-that of writing the chemical formulas of the constituents of a remedy in a way to indicate a chemical combination.-(From The Journal A. M. A., Nov. 5, 1910.) CAPUDINE Another of "The Subtle Poisons" A great many inquiries reach the Association's laboratory regarding various nostrums and "patent medicines" with requests for analyses, but the number of preparations thus brought to notice is so great that it would take an army of chemists to satisfy all inquiries. As it is, only such prepara- tions are examined as will serve as examples of a class of nostrums which it is desired to expose or that are of special interest to the profession. Hick's Capudine Cure-or as it is known to physicians "Elixir Capu-Hicks"-is one of such examples, and its investigation has been deemed advisable. manufacturers' claims The manufacturers - the Capudine Chemical Company, Raleigh, N. 0.-issue two kinds of advertising pamphlets;- one for physicians and another for the public. The medical profession is told that Capudine is . . . especially recommended for the relief of all headaches, colds, la grippe, neuralgia, sick headache, nervous headache, acidity, flatulency, and indigestion pains, also for dysmenorrhea, after pains, etc. Ml SC ELL AN EO US NO ST 11 UMS 167 A formula of the type that usually accompanies prepara- tions of this character is given: Elixir Capu is composed of the combined Bromids of Potassium, Sodium and Ammonium, Caffein, Capu, Elixir Peppermint, Adjuvants and Correctives, Syrup and water, q. s. To elucidate further and for the information of those who have never heard of the substance capu, we are told': Capu is a cellulin product-Chemical formula Ci8H2oN304 posses- sing very powerful analgesic properties and is a mild antipyretic. In a "Laundry List" pamphlet extolling the virtues of the remedy, the public, are informed that Hicks' Capudine CURES all headaches, indigestion, la grippe, colds, etc. No remedy ever placed before a suffering mortal has the wonder fully quick powers of Capudine. Hicks' Capudine is not a "dope" ; will not produce a habit. Try this splendid remedy and enjoy life once more. Capudine is a liquid, acts immediately and is sold by dose at soda founts, and in 10, 25 and 50c bottles at drug stores. LABORATORY FINDINGS Capudine (whether in the form of Elixir Capu-Hicks, or as Hicks' Capudine Cure) is a brown, rather syrupy liquid, slightly alkaline to litmus, with an aromatic odor and a salty taste. Besides 8 per cent, of alcohol, Capudine -was found to contain sugar, aromatics, chlorids, caffein, antipyrin and salic- ylates. Quantitative estimations demonstrated the presence of about 1.25 gm. (19 grains) of antipyrin and caffein to each fluid ounce, and salicylates equivalent to about 0.9 gm. (14 grains) of salicylic acid to each fluid ounce. Thus Capudine depends for its action principally on antipyrin. COMMENTS As a barefaced attempt to exploit, at the same time and with the same preparation, both the medical profession and the public, this nostrum is probably preeminent in the annals of the "patent medicine" business-a business whose claims to deceit and mendacity are already high. That medical journals should aid and abet such methods would seem unbelievable. Testimonials are forthcoming, of course. In the pamphlet to the laity, these come from the butcher, the baker and the candlestick maker, while in the "literature" to physicians, at least some of the testimonials-"case histories," if you please! -come, it is needless to say, from our old testimonio-maniac friend, W. T. Marrs,1 M.D., of Peoria Heights, Ill. As Dr. 1. See The Journal, March 14, 1907, p. 897. 168 PROPAGANDA FOR REFORM Marrs has recommended, at various stages of his literary career, such remedies as Neurilla, Antikamnia, Bromidia, Chionia, Arsenauro, Cactina Fillets, Thialion, Phenoseptine, Papine, Calcidin and others too numerous to mention, his opinion regarding Capudine must be considered authoritative. Dr. A. S. Reed of Naples, Maine, also details a "case history" in which the marvelous results achieved by the administration of Capudine are surpassed only by the still more marvelous spelling and composition of the testimonial. Reproduction (reduced) of an advertisement of Capudine in a medical journal (Medical Summary). In this way the physician is reached. Reproduction (reduced) of an advertisement to the public appearing in a religious pub- lication, the Baptist Flag. In the lay press we find Capudine extensively advertised in the typical "patent medicine" style. In the "Laundry List" pamphlet, previously referred to, which goes direct to the public, there are graphically portrayed some of the conditions in which Capudine is indicated. For the purpose of determining the attitude of the Capudine Chemical Company regarding its policy of combining the "patent medicine" and "ethical proprietary" business in one and the same preparation, a Chicago physician wrote, asking if it made any particular difference whether he wrote a pre- scription for Elixir Capu Hicks or told his patients to go to MISCELLANEOUS NOSTRUMS 169 the drug store and ask for a bottle of Hicks' Capudine Cure. The Capudine Chemical Company rose gracefully to the bait and swallowed it hook and line. The answer, dated Sept. 28, 190'8, is so ingenuous and enlightening that we give it almost in full. For the purpose of emphasizing certain passages we have employed italics and small capitals: "We use the name Elixir Capu-Hicks so that Doctors can write for it and have their prescriptions filled without the consumer knowing that it is the same thing as the advertised product. A great many of our doctor friends prefer this. "In regard to the cost to the druggist it is the same and we presume that most druggists dispense Capudine by THE DOSE OVER THE COUNTER AND ELIXIR CAPU-HICKS ON PRESCRIPTION FROM THE SAME ONE-PINT OR ONE-GALLON BOTTLE OF CAPUDINE, WHICH IS PERFECTLY ALL RIGHT [! !]. Though some of our drug friends buy it labeled as Elixir Capu-Hicks specially for their prescription trade." Reproduction from the Atlanta (Ga.) Constitution, Sept. 15, 1908, which gives the lie direct to the statement that Capudine "does not contain poisonous drugs." "Perfectly all right" indeed! What though you deceive your patient, stultify yourself and use your druggist as a catspaw; just so you increase the sale of Capudine it "is perfectly all right"-for the Capudine Chemical Company. The formula furnished physicians is, of course, a joke. The various ingredients given-without quantities-are, with the exceptions of Capu, well-known drugs. Capu is not so well known; in fact, its circle of acquaintances is limited to the Capudine Chemical Company. According to the company (and if it doesn't know, who does?) "capu is a cellulin product- chemical formula C1SH2()N3O4." This looks abstruse and scien- tific, and doubtless in many cases prevents further impertinent 170 PROPAGANDA FOR REFORM and awkward questions. The description only lacks one thing to prevent it qualifying for an honored position in the hall of fakes-a "structural formula" of weird and impressive design. The great unknown-Capu-is, of course, as the analysis demonstrates, our old friend antipyrin. On the "literature" furnished physicians and on the advertising distributed to the public, great stress is laid on the fact that Capudine "contains no acetanilid." This puts the nostrum in that dangerous class of "patent medicines," increasingly common of late, in which a heart-depressing drug is present, but one, unfortunately, which the Food and Drugs Act does not require to be specifically named on the label. Mr. Adams, in the "Great American Fraud" series says, in speaking of the labels on "patent medi- cines:" "If the words "warranted harmless' appear any- where, look twice over for the Ethiopian in the woodpile." We would say if the words "contains no acetanilid" appear on the label of any "headache cure," it is a safe guess that some other equally dangerous heart-depressant is there in its place. The statements that (1) "Hicks' Capudine is not a 'dope'"; (2) "does not contain . . . poisonous drugs," and (3) "will not produce a habit," are three separate and dis- tinct falsehoods. As to its "harmlessness," a telegram that appeared in the Atlanta (Ga.) Constitution, which we repro- duce, refutes briefly but tragically, this cruel lie. Dr. E. W. Warren, of Palatka, Fla., reports the case of a woman who was thought to have been murdered, but the state's attorney concluded that her death was caused by too much Capudine. And this hybrid "'patent medicine'-proprietary" is to be found advertised in medical journals! How much longer will the medical profession put up witli it?-(From The Journal A. M. A., Oct. 11, 1008.) DANIEL'S CONCENTRATED TINCTURE OF PASSIFLORA INCARNATA Curious Pharmacologic Action of May-Pop (Passiflora In- carnata) In perusing the "literature" of some of the fearfully and wonderfully made proprietary mixtures on the market one is uncertain whether the attitude of their manufacturers is "We aim to please" or one of "Heads we win, tails you lose." The uncanny elasticity of pharmacologic action in pro- prietaries of the type referred to is the cause of this uncer- tainty. For instance we find that both amenorrhea and MISCEELANEO US NO STU UMS 171 menorrhagia are amenable to the same remedy and it is noth- ing unusual for a nostrum to be both a stimulant and a sedative. We are reminded of this fact in perusing the "literature" of Daniel's Concentrated Tincture of Passiflora Incarnata, a proprietary marketed by J. B. Daniel, Atlanta, Ga. Ac- cording to the booklet this remedy is to be employed in both convulsions and paralysis. Unlike many nostrums the pro- prietor claims to base his recommendations on exact phar- macologic investigations of which he produces two brands; the doubting physician pays his money and takes his choice. If he has a case of convulsion let him consult the laboratory report of Dr. Isaac Ott, who tells us that "in Passiflora In- carnata we have a drug of considerable power producing a de- pressant action on the reflex activity of the spinal cord." If, on. the other hand, the physician has a case of paralysis to deal with he should turn over the page and take the authority of the certificate of the "lamatological Bureau" which states, "it notably exalts the reflex function of the spinal cord." Let the doctor in search of a hypnotic that is not a hyp- notic and a powerful remedy that "does not endanger the heart" take his choice between these two contradictory actions. It is all the same to the nostrum maker so long as the doctor uses his "only reliable preparation of May-Pop" for all cases, every time and all the time. But, seriously, isn't it about time that such opera bouffe methods of presenting medicinal agents to physicians should be resented by the medical profession? Disease itself is a serious thing and the treatment of disease is no trifling mat- ter. The attempt to induce physicians to use a preparation by investing it with incongruously contradictory virtues neither flatters the intelligence of the medical profession nor invests pharmacy with any degree of dignity.-(From The Journal A. M. A., Oct. 9, 1909.) DEKOFA A Caffein-Poor Coffee To those who would indulge their cravings, but whose health will not permit such indulgence, alcohol-free beer, nicotin-free cigars and caffein-free coffee is an ever-alluring subject. Unfortunately these articles have in the past been free from their objectionable constituents in name only, or if true to claim were unsatisfactory substitutes for the real 172 PROPAGANDA FOR REFORM articles-for beer without alcohol, tobacco without nicotin and coffee without caffein is much like "Hamlet" with Hamlet left out. In the end, those whose health interdicts the use of these stimulants wisely become total abstainers rather than consumers of unsatisfying substitutes, which but perpetuate the craving. Recently a "decaffeinated" coffee, advertised and sold in this country by Merck & Co., first as "Dekafa" and now as "Dekofa," has attracted some attention, judging from the inquiries received regarding it. It is evident from these inquiries that physicians in view of past experiences no longer rely on the unconfirmed statements of manufacturers but require more convincing evidence than such statements before accepting the product for what it is sold. In view of the many inquiries regarding Dekofa the Association chemists investigated the product and report: Dekofa is sold on the retail market in 1-pound packages labeled: "Dekofa-a genuine coffee from which the stimulating drug caffein has been largely removed. Particularly adapted for those to whom ordinary coffee is forbidden." "Use precisely as ordinary coffee-no special directions for making are needed." Besides the above the following statements, some addressed to the laity and others to the profession are found in the advertising matter: "Does the doctor forbid you coffee? Then ask him about Dekofa or Merck's 'Caffeinless' coffee. Most probably he'll let you drink that-and lots of it too." "Drink it at home and you won't have to drink it in Europe- and you may not have to go to Europe for your health, either." "There is no need of you forbidding coffee to your patients troubled with 'heart' or 'nerve' or 'stomach' complaints, if you will direct them to use Dekofa, Merck's 'Caffeinless Coffee.' " "The average caffein content of ordinary coffee is 1.3 per cent. Dekofa contains approximately 0.13 to 0.15 per cent, of caffein or about 10 per cent, only of the normal content." From the standpoint of the chemist the claims made by the manufacturer bring up for discussion the following points: Dekofa is spoken of as "Merck's Caffeinless Coffee." This term would signify that the coffee is free from caffein but as the firm makes a statement that the product contains 0.13 to 0.15 per cent, caffein it is evident that here the manufac- turers seek exemption from the truth under a sort of poetic license enjoyed in the past by "patent medicine" exploiters. The use of the phrase "caffeinless" can do but one thing- disguise the truth and hence should be dropped. MISCELLANEOUS NOSTRUMS 173 The firm asserts that "the average caffein content of ordi- nary coffee is 1.3 per cent." According to published analyses the caffein content of coffee varies from 0.64 per cent.1 to 3.64 per cent.2 This variation is due in part to natural causes and in part to the unsatisfactory methods of assay. Thus one investigator finds in coffee of different sources 0.64 to 1.53 per cent, caffein,3 while three experimenters, working on the same specimen of coffee, reported, by the provisional method of the Official Agricultural Chemists, results ranging from 0.28 per cent, to 0.89 per cent, caffein and by another method from 1.02 per cent, to 1.21 per cent, caffein. These results make it evident that no reliable average caffein content for coffee can be given, particularly when the method of assay is not defined. We are not in a position, however, to deny the correctness of the average caffein con- tent of coffee as given by Merck & Co., nor, therefore, the claim that the presence of 0.13 per cent, caffein is an indica- tion that 90 per cent, has been extracted. Assuming for the present that 0.13 per cent, caffein does indicate the removal of 90 pei' cent., and in view of repeated inquiries it was decided to determine whether the actual caffein content of this product on the market agrees with the manufacturers claims. To determine the caffein content (1) the modified pro- visional method of the Association of Agricultural Chemists {loo. cit.) and (2) a method proposed by Gorter {ibid.) were used and the following results obtained:4 1. (a) 0.13 per cent.; {b) 0.17 per cent, or an average of 0.15 per cent, caffein. 2. {a) 0.21 per cent.; {b) 0.25 per cent, or an average of 0.23 per cent, caffein. Although these results vary somewhat, due to the different methods of assay used, they show that the caffein content of the product agrees in general with the claims. In conclu- sion it may be said that in those cases in which physicians feel called on to interdict the use of coffee and in which the patient is not willing to give up the habit, this product-unsatisfying as it is-may be used with the knowledge that it is relatively free from caffein.-(From The Journal A. M. A., July 1,1911.) 1. Arch. Pharm., 1876, p. 294. 2. Allg. Kaffee Zeitung, Rotterdam, from Proc. Amer. Pharm. Assn., 1885, p. 144. 3. Arch. Pharm., 1876, p. 294. 4.'The details of analysis will appear in the annual report of the Association laboratory. 174 PROPAGANDA FOR REFORM ECTHOL Ecthol, advertised in a style typical of nostrums, is said to contain as its active ingredients Echinacea angusti- folia (Pale Purple Cone Flower) and Thuja occidentalis (Ar- bor Vitae). Neither of these drugs is official in the U. S. Pharmacopeia and information concerning their therapeutic value amounts practically to unverified claims that they are useful as alteratives and in certain inflammatory conditions. The viciousness of vaunting an internal remedy for serious septic conditions without ample basis of fact is self-evident. A pamphlet before us, entitled "Ecthol in the Sudan," is a fine example of nostrum advertising, calculated to captivate the unthinking physician with its show of science and to mislead him into believing that the remedy exploited has been endorsed by high authority. It begins with a eulogy of the Wellcome Research Laboratory at Khartum, Sudan, and its second report, and the work of the laboratory is described and praised. In close connection with this praise of legitimate scientific work, we are told that ecthol is used in the Sudan, "and that it is regarded as almost a specific in certain classes of diseases." The reader is left to infer that its use is described in the report, although the advertiser is careful not to say so. Three pictures of patients with small- pox, chickenpox and syphilitic ecthyma, respectively, are re- produced from the report and without apparent break in the article we are told that "it is in precisely such cases that ecthol gives its most striking results." Of course, the Well- come Research Laboratory report contains no such mention of ecthol. While such attempts to bolster up a preparation by weaving its praises into an account of a strictly scientific report may be "good business," it is in fact prima facie evidence of the valuelessness of a remedy apparently unable to stand on its own merits.-(From The Journal A. M. A., March 13, 1309.) ENTERONOL The "Greatest Germicide Known to Science"! This preparation is put on the market by the Enteronol Company, Oswego, N. Y., which declares that Enteronol is "the greatest antiseptic and germicide known to science," and that it "destroys the germs of typhoid fever, acute and chronic diarrhea, dysentery, cholera infantum, cholera morbus, sum- MISCELLA.NEO US NOSTRUMS 175 mer complaint, Asiatic cholera, etc., within two hours." The formula furnished by the company reads as follows: "Ipecac, sub. nit. bismuth, latalia rad., camphor, lupulin, caffein and rheum." The attention of the Council on Pharmacy and Chemistry of the American Medical Association was directed to this preparation by a correspondent who had received a circular from the Enteronol Company. He sent a dollar to the company asking for a sample of "latalia rad." that he might study the drug botanically, as he was unfamiliar with it. He expected to receive by return mail a sample of root or bark, but instead, he received three boxes of Enteronol and the information that as "latalia rad." costs from $25 to $45 a pound the company could not afford to send samples. In a circular letter sent out by this company "latalia rad." is said to grow on the sides of the Himalaya Mountains in India, and that the company is unable to obtain enough for its own use. This statement is probably correct, and no one else could secure the drug either. A sample of Enteronol was submitted to Professor Day, of the University of Illinois, and to Pro- fessor Kraemer of the Philadelphia College of Pharmacy. Professor Day reports that he was "unable to find any men- tion of the drug 'latalia rad.,' which is stated as one of the ingredients of this preparation. I have searched the usual works of reference on pharmacognosy without being able to find any reference to a drug of this name. A microscopic examination of the tablets shows the presence of rhubarb and of ginger, but no lupulin, at least not in substance; nor could I locate definitely any ipecac, also stated to be one of the ingredients. Since ginger is not stated to be one of the ingre- dients of the compound, it, perhaps, may be the mysterious stranger 'latalia rad.' I was unable to locate any of the ordinary astringent drugs, such as kino, grameria, or nutgall." The results of Professor Kraemer's examination were practi- cally identical with those obtained by Professor Day. A report from the chemical laboratory of the American Medical Asso- ciation states that as Professors Kraemer and Day suggested the presence of alum, tests were made for this substance. The analysis, details of which are given, leads to the conclu- sion that alum is the chief constituent of Enteronol. The report adds strongly to the impression that "latalia rad." is simply a ruse to catch the unwary and trusting physician who lacks the time to look into the botany of every new plant dis- covered, and who is willing to trust the honesty of every manufacturer.' Attention is also directed to the fact that while bismuth and caffein are mentioned as ingredients tests 176 PROPAGANDA FOR REFORM made in the laboratory failed to discover either of these sub- stances. Since there is no lupulin, no ipecac, no caffein, no bismuth, and possibly no "latalia rad." one is forced to the conclusion that the "formula" is meaningless and worthless, and that it is used simply to satisfy the demand for formulas for proprietary remedies. This is one more beautiful illus- tration of the absurdity of accepting a preparation because the "formula is on every package."-(Abstracted from The Journal A. M. A., March 21, 1908, p. 977.) An Invitation to The Journal to Humbug the Profession The Journal has received a circular letter from the Entero- nol Company, in which the following liberal offer is made: "We are willing to take one-fourth or one-half page 'ad' in your Journal for a year at the regular rate, on condition that you ac- cept payment therefore in our GUARANTEED 7 per cent., preferred stock at par; or if you desire, in ENTERONOL at the net wholesale price to physicians." Not that this offer is made exclusively to The Journal: "A large number of medical journals have accepted the foregoing proposition; many carrying this advertising for several years al- ready." "Our company is cooperative; we paying no cash for advertising. The company is owned principally by physicians, medical journals, and druggists." The journals of which we have record that carry the enteronoj advertisement are: ' Kansas City Medical Record, Milwaukee Medical Journal, Toledo Medical and Surgical Re- porter, Proctologist, Pediatrics, and the Atlanta Journal- Record of Medicine. If the statements made by the Enteronol Co. are true, we might infer that these journals are being paid for advertising space either with "preferred stock" or with the nostrum itself. As we have previously shown, however, the veracity of the enteronol advertising matter is by no means unimpeachable. Enteronol, it will be remembered, was exposed in The Journal, March 21, 1908. It is advertised as the "greatest antiseptic and germicide known to science," and possesses (?) such remarkable power that it "destroys the germs of typhoid fever, acute and chronic diarrhea, dysentery, cholera infan- tum, cholera morbus, summer complaint, Asiatic cholera, etc., within two hours." "The original product is found only high up on the sides of the loftiest mountains in the world-the Himalayas of India." MI SC ELL A NEO US NO STR UMS 177 THE "LITEBATUBE" FOBMULA Of course it has a "formula": Ipecac Sub. nit. bismuth Camphor Latalia rad. Lupulin Caffein Rheum This seems very open and above board, except as to quan- tities, until one tries to find out what "latalia rad." is; then it is discovered that it is the "mysterious stranger" of phar- macognosy. Experts to whom this "remedy" was submitted were unable even to find mention of such a drug or plant as "latalia rad." Nor was this the only fake found concerning the stuff; carefully conducted experiments repeatedly carried out in the Association's laboratory failed to disclose even a trace of bismuth subnitrate or caffein. These experiments did show, however, that the tablets contained an amount of alum- inum corresponding to over 25 per cent, of crystallized alum. This led to the conclusion that alum, whose presence is not even hinted at in the "formula," is the chief constituent of enteronol and as a corollary that the formula is meaningless and worthless. THE LABEL FORMULA There is a curious lack of coordination between the "formula" as printed on the label and that given in the "literature." The Food and Drugs Act, it will be remembered, makes lying on the label illegal, and therefore dangerous; statements in advertising matter that does not accompany the product, how- ever, are not controlled by that law. The "formula" in the "literature" we have already given; the "formula" on the label gives the following ingredients: Ipecac Sub. nit. bismuth Camphor Lupulin Caffein Rheum Opium, % gr. Two things about this are worth noting: One is that the name of the ingredient on which the manufacturer lays so much stress-latalia rad., the mysterious Himalayan plant- is absent from the label. This would seem to indicate that what has already been intimated by The Journal-namely, that latalia rad. is a figment of the imagination--is a fact. The second noticeable thing about the label "formula," as distinct from the "formula" in the advertising matter, is that on the label we find there is opium in the preparation. Why is no mention made of the presence of this potent drug in the advertising matter? To determine how nearly the present statements made by the Enteronol Company approximate truthfulness, our chem- 178 PROPAGANDA POP REEORM ists were asked to examine the nostrum as it is now sold. Their report follows: LABORATORY FINDINGS An original package of enteronol tablets was purchased on the open market and submitted to the Association laboratory for examination. In general appearance, odor and taste the new tablets are similar to those previously examined. The formula for the old tablets was given as "Ipecac, Sub. nit. bismuth, Latalia rad., Camphor, Lupulin, Caffein, Rheum," and is still used in the circulars. But the label on the trade pack- age no longer mentions "latalia rad." Since the presence of "latalia rad.," in the old tablets, was questioned, and as new labels have ceased to display the name, it was thought pos- sible that caffein and bismuth might now be constituents of enteronol, as the drugs are still mentioned in the new formula on the label. Accordingly, enteronol was examined chemically to verify the statements on the label regarding the presence of caffein and bismuth in the tablets. The specimen submitted to the laboratory some time ago was found to contain neither bismuth nor caffein. By employ- ing the same methods as were used before (the usual tests for detecting caffein and bismuth), neither caffein nor bismuth could be demonstrated. It is thus evident that this new speci- men of enteronol, the statement on the label to the con- trary notwithstanding, contains neither bismuth nor caffein- at least, in appreciable quantities. One would think that the discrepancy between "formulas" and facts would prove of interest to the stockholders of the Enteronol Company, especially as we are told that the policy of the company is to have "practical men as stockholders." We are informed: "Therefore, we have physicians, advertising experts, printers, pub- lishers, engravers, boxmakers, lithographers, druggists, lawyers, trav- eling salesmen, officers and men holding executive positions in vari- ous manufacturing and commercial corporations, editors of medical publications, bishops, clergymen and missionaries-men from all the fields particularly valuable commercially for our great enterprise." Yet if the physician-stockholders do not care to concern themselves about the composition of the nostrum from the sale of which they derive dividends, it can hardly be expected that the boxmakers or traveling salesmen will be interested. STOCK FOR SALE Medical journals are not alone in being invited to partici- pate in the exploitation of this nostrum, vide a circular letter from the Enteronol Company addressed "To Investors": MI SC ELL MN EO US NOSTR UMS 179 "We offer at par of $10 each, 1,000 shares of our Guaranteed 7 per cent. Preferred Stock, cumulative dividends, payable quarterly . . . Profits on business done last year were 54 cents for every dollar expended . . . We guarantee absolute security for your investment. Safer than a bank." [Italics ours.-Ed.] We are told that at present the Enteronol Company manu- factures two products: a castor-oil preparation, known as fig-ol, and enteronol. Very shortly, however, the company ex- pects to ''add seven equally efficient products." "The average cost to manufacture, ready to ship, a dollar's worth of these goods is less than ten cents." "In enteronol alone, the company has fortunes and the only thing needed to bring tremendous results and dividends of 100 per cent, is the proper amount of judicious advertising." Here are some samples of the judicious (?) advertising: "One Christian missionary, the Rev. Paul Singh of Jubbulpore, India, testifies that he cured thirteen severe cases of Asiatic Cholera with a box containing less than thirty tablets" [of enteronol]. "Wm. F. Oldham, bishop of Southern Asia, writes us that en- teronol cured nine cases out of ten of Asiatic Cholera. Now just think of India and China with their 800,000,000 people who are dying by the thousands of a disease which we have the power to cure so easily." How like a discourse by that delightful character of Mark Twain's-the visionary Colonel Sellers-this reads. As he said about his "Infallible, Imperial, Oriental Optic Liniment:" "Why in the Oriental countries . . . every square mile of ground upholds its thousands on thousands of struggling, human creatures-and every separate and individual devil of them's got the ophthalmia." The prospective stockholder is told that an ordinary busi- ness concern reaches the limit of financial possibilities in a few years, but: "Not so with the Enteronol company-it is a mail-order business and the world is its territory." Even so with Colonel Seller's "Optic Liniment:" " . . . it's a patent medicine whose field of operations is the solid earth." And we are told elsewhere that "about four-fifths of the outstanding stock is held by the medical profession alone"! And this stuff is advertised in medical journals!! We are sometimes in danger of being too optimistic regard- ing the results of the propaganda for reform in proprietary medicine. Cases like this act as a corrective.-(From The Journal A. M. A., Nov. 20, 1009.) 180 PROPAGANDA FOR REFORM GLYCO THYMOLINE Difficulty of Determining the Formula In answer to the question: "Will you please inform me where I can find the formula for Glyco Thymoline, The Jour- nal says: We cannot! Had "a" formula instead of "the" formula been asked for, we could have referred to various advertisements of this preparation. For instance, in the Bos- ton Medical and Surgical Journal we find "a" formula as fol- lows : Sodium 24 Boric Acid 4 Benzoin 4 Acid Salicylic 0.33 Eucalyptol 0.33 Thymoline 0.17 • Betula Lenta 0.08 Menthol 0.08 Pin! Pumilionis 0.17 Glycerin and solvents q. s. In the Texas State Journal of Medicine of the same date we also find "a" formula which varies to such an extent with other "formulas" that the editor of this journal, Dr. Chase, refused longer to carry the Glyco-Thymoline advertisement. Benzo-Salicyl. Sod 33.33 Eucalyptol 0.33 Thymol 0.17 Salicylate of Methyl, from Betula Lenta. ... 0.1(1 Pini Pumilionis 0.17 Glycerin and solvents q. s. In the New York Medical Journal of December 5, there is "a" formula which is similar to the one in the Texas journal, except that it has added to it: Menthol 0.08 Examination of the preparation in the chemical laboratory of the American Medical Association showed that it contained no boric acid, but instead borax; that salicylic acid was not present as acid, but as its sodium salt; that benzoin instead of being present in comparatively large quantities, was prac- tically absent, and sodium benzoate was in its place; that the compound "benzo-salicyl, sod." was absent, and there was instead, a mixture of sodium benzoate and sodium salicylate. The results obtained in the Association's laboratory are corroborated by the work of Dr. J. Kochs (Apotheker-Zeitung, 1907, xviii, 169). Dr. Kochs states that Glyco-Thymoline is an alkaline solution containing potassium carbonate, sodium MISGELL A NEO US NO STR UM S 181 benzoate, sodium salicylate, borax, thymol, menthol, glycerin and alcohol. The published formulas, therefore, disagree, not only among themselves, but with the facts. When purchasing proprietary preparations with such fickle formulas, "you pay your money" for the preparation-"and take your choice"-of formulas.- (From The Journal A. M. A., Jan. 9, 1309.) GONOCOCCIDE "Gonococcide" is a preparation sold by Cox Chemical Co., Chicago. The circular accompanying the package gives the following formula: C8H8BrNO monobromacetanilid; C10II44N2C7HO3 eudermol; CaS32H2O gypsum and selenite, CaSo^ anhydrite; H2O aqua and myrrh. Note.-In combining calcium coral with sulphuric acid, calcium occurs as gypsum, selenite and anhydrite. Gypsum, selenite and anhydrite are the names applied to different forms of calcium sulphate. . Gypsum and selenite are chemically identical, being calcium sulphate and containing two molecules of water crystallization, CaSO4 + 2H2O, but differing in crystalline form. Anhydrite is also cal- cium sulphate, but contains no water of crystallization. The inclusion of three different forms of the same substance should be sufficient to demonstrate the "fakeness" of the formula. The first substance named, monobromacetanilid, has been used as an antiseptic under the trade names of antisepsin and asep- sin. It is practically insoluble in water, and hence but little of it can be contained in the preparation. Eudermol is a name given to nicotin salicylate and its use externally has been rec- ommended in scabies, chronic eczema, and other skin diseases. This being practically the only medicinal constituent given in the formula, its determination in gonococcide was taken up in the Association laboratory. Tests, however, failed to show the presence of this or any other alkaloid. While the addition of iodin to a 0.1 per cent, nicotin salicylate solution produces an abundant precipitate, the addition of iodin to a specimen of gonococcide produced no reaction whatever. Further comment on the formula seems to be unnecessary.-(From The Journal A. M. A., Aug. 2^, 1901, 108.) 182 PROPAGANDA FOR REFORM HEADACHE CURES The Harmful Effects of Acetanilid, Antipyrin and Acetphenetidin The United States Department of Agriculture Bulletin1 No. 126, issued July 3, 1909, sets forth the results of an investiga- tion conducted by the Bureau of Chemistry with regard to the harmful effects of acetanilid, antipyrin and acetphenetidin. During recent years the use of these remedies and prepara- tions containing them by the people at large, without the su- pervision of the physician, has increased rapidly and investi- gation has shown that coincidently there has been a marked increase in the number of cases of poisoning reported, in the number of fatalities, and in the number of instances of habitual use. Since the passage of the Food and Drugs Act, June 30, 1906, the attention of the Department of Agriculture has been di- rected to this subject, particularly in connection with the branding of drug products containing one or more of these agents, and an attempt has been made to obtain full and reli- able data with regard to their poisonous qualities with the object of furnishing information to the public which would enable them to understand that these remedies should be em- ployed with caution in the absence of reliable medical advice. The investigation was conducted along two lines: First, an inquiry addressed to medical practitioners in the United States with regard to their personal experience with these drugs; and, second, the study of the cases of poisoning re- corded in medical literature. Nearly a thousand letters, each containing eighteen questions, were addressed by the depart- ment to physicians throughout the country, »the object being to secure information which would represent as closely as pos- sible the conditions existing among the people at large so far as the harmful effects of the drugs in question are concerned. Four hundred replies were received. The information obtained with regard to the number of in- stances quoted in medical literature in which poisoning, death, or habitual use has been known to result from the adminis- tration of acetanilid, antipyrin, and acetphenetidin is set forth in Section A of the accompanying table. The information summarized in Section B is based on the data submitted by physicians. Granting that the 525 physicians who did not 1. The Harmful Effects of Acetanilid, Antipyrin and Phenacetin, by L. F. Kebler, Ph.G., M.D., chief Division of Drugs, Bureau of Chemistry, with the collaboration of Drs. F. P. Morgan and Philip Rupp, assistant chemists. MISCELL AN EO US NOSTRUMS 183 reply had no cases to report, the question may profitably be asked, if 925 physicians have observed 814 cases of poisoning by these drugs, 28 deaths which are attributed to their use, and 136 instances of habitual use, how many such cases have in all probability been observed by the 125,000 physicians scattered throughout the United States? The summary, C, includes both the number of cases recorded in medical litera- ture and those reported by physicians. POISONING BY ACETANILID, ANTIPYRIN AND PHENACETIN A.-Cases Recorded in Medical Literature POISONING. DEATH. HABITUAL USE. Acetanilid 297 13 32 Antipyrin 488 10 Acetphenetidin 70 3 i Total 855 26 33 B.-Data Submitted by Physicians habitual poisoning. death. USE. Acetanilld 614 16 112 Antipyrin 105 5 7 Acetphenetidin 95 7 17 Total 814 28 136 C.-Total Number of Cases habitual USE. POISONING. DEATH. Acetanilid 911 29 144 Antipyrin . 593 15 7 Acetphenetidin . 165 10 18 Total 1.169 54 169 The bulletin contains information with regard to dosage, the extent to which these drugs are employed by physicians, poisoning and habitual use, the nature of the ill effects pro- duced, etc. It also contains references to the recorded cases of poisoning, together with a brief abstract of each case. -(From The Journal A. M. A., July 31, 1909.) Sanatoriums and tie Acetanilid Habit To the Editor:-I enclose herewith a "form" letter and ques- tion blank which I received recently from St. Louis. I may be entirely too wary but I am suspicious that this is a collec- tion of "statistics" to combat the work of the medical pro- fession in educating the physician and the laity in the harm- fulness of acetanilid and similar preparations. G. H. Benton, M.D., Chester, W. Va. Sterling-Worth Sanitarium. Comment: The letter which Dr. Benton encloses is in fac- simile form and purports to come from Uriel S. Boone, M.D., of St. Louis, who states that he is "preparing an exhaustive article for publication in a leading medical journal" on the 184 PROPAGANDA FOR REFORM question, "Is acetanilid a habit-forming drug?" To obtain the necessary data Dr. Boone is "writing to every hospital and sanitarium in the United States." Examination of the ques- tion blank which accompanies the form letter discloses the fact that information is wanted regarding not acetanilid alone, but also antipyrin and acetphenetidin (phenacetin). The last question asked runs as follows: "If your records (of cases of habitual use of these drugs] are incomplete, would you allow a reputable physician to investigate the above mentioned cases so that he could write with positiveness about them, and, if necessary, make oath to the truth of his report?" [Italics ours.-Ed.] Dr. Boone opines that the recipients of his queries "may hesitate to answer" the question just quoted, but he trusts that its importance will be evident when he explains that "it is currently reported that the manufacturers of acetanilid, phenacetin, etc., have decided to prosecute all libelers of these drugs" [Italics again ours.-Ed.] and he wishes to make no statement that he "can not substantiate under oath." Surely the life of the collector of medical statistics is unusually hazardous. For the purpose of aiding Dr. Boone in his arduous search for truth on the "much mooted question, 'Is acetanilid a habit- forming drug?'" we direct his attention to a work that should prove of invaluable assistance. We refer to Bulletin 126 of the Bureau of Chemistry, entitled "The Harmful Effects of Acetanilid, Antipyrin and Phenacetin." This interesting study to which we have previously called attention, records 112 cases of the acetanilid-habit. Of this number, at least 50, or 44.6 per cent, of the cases were those of patients who took proprie- tary preparations of the drug. From this we would not wish to give any bias to Dr. Boone's statistics. We hardly expect, however, that such will be the case. Dr. Boone's name appears as the author of an article entitled "A Therapeutic Study of Antikamnia and Heroin Tablets"-an article that has been very extensively "quoted" and has been sent out in its entirety by the Anti- kamnia Chemical Company. Under these circumstances we may be forgiven if we venture the opinion that Dr. Boone is not likely to be unduly prejudiced against "headache tablets" in general and fake "synthetic" coal-tar mixtures in particular. We await with breathless interest the appearance of Dr. Boone's "exhaustive article" and we must confess to some degree of curiosity regarding the name of the "leading medical journal" in which these invaluable data will appear.-(From The Journal A. M. A., Aug. l.'i, 1909.) MI SC ELL A NEO US NO STR UMS 185 HYDRONAPHTHOL A correspondent having requested information regarding the composition of "Hydronaphthol," the product was investigated in the Association laboratory. The laboratory reports as follows: Hydronaphthol is sold by Seabury & Johnson. The label on a trade package of Hydronaphthol gives no clew as to the nature of the product. The statements on the labels do, how- ever, make the claim that Hydronaphthol is an antiseptic of great power, also that it is non-toxic and therefore may be used with impunity; thus the following statements are made: "A harmless, practically odorless, non-poisonous, non-corrosive antiseptic. . . . ." ". . . it is non-poisonous and can be employed with perfect immunity as a preservative . . . ." The substance has the characteristic appearance, odor and taste of naphthol. It responded to all the tests of the United States Pharmacopeia for betanaphthol, with the exception of the melting point, which was found to be 119 C. instead of 122 C., an indication of impurity. It is evident, therefore, that Hydronaphthol is merely a trade-name for betanaphthol. While resublimed betanaphthol is listed at 10 cents an ounce, Hydronaphthol is listed at 75 cents an ounce. • Hydronaphthol thus furnishes one more illustration of the fact that most proprietary medicines for which the most extravagant claims are made are but old and well-known remedies sold under a fancy name at a price far in advance of that charged for the constituent or constituents. The exploiters are extremely positive in their statements regard- ing the non-toxic character of the preparation. Yet, as a matter of fact, betanaphthol is by no means harmless; it has been absorbed by the diseased skin with injury to the kidney and with fatal results. In some cases injury to the eye has also occurred. These toxic actions should be known to the practitioner. From 3 to 4 gm. (1 dram) applied to the skin has produced death (Stern: Therap. Monatshefte, 1900, p. 105). When a manufacturer advertises a prepara- tion which possesses potentialities for harm, and especially when he puts it out under a name which conceals its identity, it is incumbent on him to warn the customer of possible injurious or inconvenient actions instead of proclaiming that the preparation is harmless.-(From The Journal A. M. A., Sept. 3, 1910.) 186 PROPAGANDA FOR REFORM HYDROZONE AND TONGALINE Hydrozone The moral principle governing the action of secret proprie- tary and patent medicine men is an unknown quantity; some- times it would seem to be a negative one. Just how much lower in the scale of humanity a man can go than to prey on the fears of a people in the time of a terrible epidemic for the sake of a few dollars we do not know. There may be something more despicable, but what is it? Two weeks ago we referred to the cold-blooded methods of the peruna people; this week we reproduce an advertisement from the New Or- leans States that tells another story of man's inhumanity to man. This brings up the problem that we are trying to solve, viz.: "What is the difference between a 'secret proprietary medicine' advertised in medical journals to physicians and a 'patent MISCELLANEOUS NOSTRUMS 187 medicine' advertised in newspapers to the public?" Hydrozone is being advertised in nearly all medical journals, and at the same time in newspapers. Where shall we place it? And if hydrozone, with the methods recently adopted to exploit it, is tolerated in the medical press, why not peruna? Tongaline Tongaline, too, is good for yellow fever if we are to believe the absurd claims made by its enterprising salesmen. Here is the advertisement from current medical journals: Stegomyia fasciata has produced an epidemic of yellow fever in certain sections of Louisiana and adjoining states. Stegomyia punctata has inoculated thousands with virulent malarial germs throughout the balance of the Mississippi Valley. Tongaline, Mellier, in one of its forms as indicated, antagonizes and destroys the effects of these parasites on account of its extra- ordinary eliminative action on the liver, the bowels, the kidneys and the pores, whereby the poison is promptly and thoroughly expelled. For full literature, etc. (From The Journal A. M. A., Sept. 23, 1906, 936.) iodonucleoid An lodin Product Under a Misleading Name Information regarding iodonucleoid having been asked for and the product not appearing in New and Nonofficial Remedies, the Association laboratory was asked to report as to the nature of this preparation. The following is its reply: This preparation was at one time considered for inclusion with New and Nonofficial Remedies, and at that time it was examined in this laboratory. The examination showed that iodonucleoid contains: Phosphorus 0.79 per cent. Calcium 0.43 per cent. (Equal to 0.6 per cent. CaO). lodin 24.2 per cent. When 2 gm. was dissolved in tenth-normal potassium hydroxid volumetric solution and acetic acid added until faintly acid, an abundant, white, flocculent precipitate formed. This precipitate was collected, washed with water, transferred to a beaker, phenolphthalein added and tenth-normal potas- sium hydroxid volumetric solution run in until a pink color was produced. This required 15 c.c. of tenth-normal alkali. Subtracting from the 2 gm. of iodonucleoid the 24 per cent, iodin, leaves 1.52 gm.; this divided by the c.c. of alkali used indicates an equivalent weight of 1013. 188 PROPAGANDA FOR REFORM Authorities differ widely regarding the amount of phos- phorus contained in nuclein from different sources, the figures ranging from 2.9 per cent, to as high as 10 per cent. If the nuclein from which iodonucleoid purports to be made contained but 2.9 per cent, phosphorus, the preparation, after allowing for 24 per cent, iodin, should still contain 2.2 per cent, phos- phorus instead of 0.79 per cent., as found by analysis. A true nuclein should contain no calcium. If iodonucleoid is a casein compound of iodin we might expect to find, if the casein had been freed from milk by acidulation without fur- ther purification, both calcium and phosphorus. The equivalent weight of casein is given by Long (Jour. Am. Chem. Soo., 1906, xxviii, 372) as 1124. This figure was obtained on a casein of high purity, and the figure of 1013 given above agrees fairly well with Long's figure for casein. The evidence, there- fore, indicates that iodonucleoid is a compound of iodin and casein, and not a nuclein compound. The findings of the laboratory were at that time submitted to Prof. John H. Long of Northwestern University, who said: "We have also made a number of examinations of iodonucleoid. We determined in it the iodin and found the amount 24.2 per cent, by weight, which is a little more than that claimed by the manufacturer. We have also tested the solubility of this substance and find it to behave about as your laboratory did. As you know, we have been making a number of preparations from casein, and recently we have determined the combining power of casein with various acids, including hydriodic acid. This acid when evaporated in moderately strong solution with casein yields finally a hard, dry mass, which may be ground up to a powder resembling very closely the prep- aration under discussion. Various amounts of iodin may be combined here, depending on the strength of the iodin solution used, and we have secured some containing over 35 per cent, of iodin. Several of these preparations resemble closely iodonucleoid, so far as solubility, appear- ance and reaction with alkalies on titration are concerned. I am unable, therefore, to distinguish this preparation from the casein compounds which we are making." From this it would appear that iodonucleoid is not a com- pound of nuclein, as indicated by the name, but instead is a casein compound of iodin. lodonucleoid, then, seems to be another one of the many iodin "substitutes" which have been put on the market. Other iodin substitutes are lodalbin, manufactured by Parke, Davis & Co.; lodipin, manufactured by E. Merck & Co., and Sajodin, manufactured by the Farbenfabriken of Elberfeld Co. As these products have been examined by the Council and found MISCELLANEOUS NOSTRUMS 189 eligible for inclusion with New and Nonofficial Remedies, phy- sicians who wish to use substitutes for potassium iodid would do well to use them instead of a product presented under a misleading name. Physicians should understand, however, that these organic iodin compounds are non-irritating because the iodin is held in such combination that it is much less active. It seems probable that they are therapeutically active only to the extent that the iodin content is dissociated from the organic compound and converted into ionic iodin. A dis- cussion of a number of iodin substitutes is found in an article by von Notthafft (Monatsh. f. Prakt. Dermat., Oct. 15, 1910, p. 343), which was abstracted and commented on in The Journal, March 4, 1911, p. 685. Von Notthafft believes that the lower degree of toxicity which these remedies exhibit has its basis in a feebler activity; either the substitutes evolve too little iodin or they split it off with greater difficulty. Physicians should, therefore, view with some distrust the claims of manufacturers that their products are not only non-irritating but at the same time possess unusual therapeutic efficiency. This will apply with especial force if there is any tendency to conceal the nature or origin of the combination.-(The Journal A. M. A., July 22, 1911.) IRIDIUM Dr. C. A. Dexter, Columbus, Ga., asks for information con- cerning the use of iridium in the treatment of acute and chronic rheumatism. Iridium is a well-known element although we have not found that it has been used as a med- icine; however, we presume our correspondent refers to "Iridium (Medicinal)," sold by the Platinum Company of America. We are not able to locate this company, but in their advertising circular "Iridium (Medicinal)" is said to be "an agent for the blood, a laxative, an alterative, indicated in all disorders of the stomach, in Jacksonian epilepsy," and "a specific in rheumatism." As to its origin, it is said in the circular, "the platinum sands are associated with and com- posed of iridium" and some other elements, so that as far as the circular gives information the nostrum is alleged to con- tain the element iridium. A few statements quoted from the circular will show that the person who wrote it knows nothing about medicine and cannot correctly use the English language: "The qualifications of Medicinal Iridium are its simplicity, purity, harmless under 190 PROPAGANDA FOR REFORM prolonged use, easily borne by the stomach." "It has been observed that when Medicinal Iridium acts as a laxative, it will regulate the same." "Called the family group, Iridium and Osmium are destined to become the world's benefactors in medicinal properties, thereby creating a new chapter in medical science." The circular quotes some supposed "excerpts from hundreds of letters on file, written by physicians, in the hope they may attract your attention," which bear marks of having been written by the same person who wrote the cir- cular. Note the quality of the following statements: "Iridium has a power, purity and simplicity that pleases me; now I can make progress." "I say to you frankly, Iridium is my stand- ard. I can get results and make progress. I am confident it aids the fibrin in the blood." "Dr. X. is pushing Iridium on five or six cases." It is not explained who Dr. X. is, but it has this to say about him: "Dr. X. is an eminent practi- tioner. He has made a remarkable record with Iridium and has so far never failed on cases of Jacksonian epilepsy; experi- mental tests have shown that Iridium increases blood-cor- puscles." The man who signs himself president of the Platinum Com- pany of America is said to be a lawyer, but is not working at it, and was formerly a promoter, fiscal agent, etc. It should not be difficult for the physician to fix the status of iridium under this sort of exploitation.-(From The Journal A. M. A., April 23, 1910.) IRON TROPON The composition of Iron Tropon seems to have varied from time to time. The manufacturers formerly stated that it contained fat, sugar, pepsin and iron in organic combination with albumin, and its use was advocated both as a food and as a medicine. It was not claimed to contain over 1 per cent, of pepsin, but tests failed to show that it contained any pepsin, or if any, such a small amount that there was not sufficient to digest the albumin in Iron Tropon itself. It was also claimed that the iron, being in organic combination with the albumin, possessed advantages over the widely used aromatic fluid preparations of iron. Tests, however, showed that the iron was not in organic combination, though even had it been, late investigations fail to demonstrate the super- iority of the organic over inorganic iron compounds. The manufacturers state in their later "literature" that Iron Tropon is a tonic and a food; that it is a compound of the MISCELLANEOUS NOSTRUMS 191 food albumin tropon, 2.5 per cent, of iron in its most assimil- able form, and enough chocolate to flavor it agreeably. It will be noted that they now make no claim for pepsin, nor do they state that it contains iron in organic form. In the dose recom- mended, a teaspoonful three times a day for an adult, the patient gets something over a grain of iron, and he might as well take an equivalent quantity of Bland's mass, the value of which has been proved. As a food, Iron Tropon, weight for weight, is about equal to beans and a little better than flour, although it contains a larger percentage of protein than either. In the dose stated, an invalid would get about 50 calories, or about 1/40 the necessary nourishment for a day. Tests also have shown that the albumin is difficult of digestion. In spite of this fact, the advertisement of Iron Tropon states: "A patient who takes Iron Tropon receives not only the benefit of iron medication, but at the same time his economy is supplied with perfectly assimilable albumin in sufficient quantity." It will thus be seen that *the claim for pepsin in this preparation has been abandoned, that the statement as to the iron being in organic form has been modified, and that the food value of the albumin is exaggerated; but perhaps the manufacturers do not expect the physician to apply his arithmetic to such problems.- (From The Journal A. M: A., April 23, 1910.) JAROMA A New Name for an Old Drug It has been frequently pointed out that most nostrums contain well-known drugs as their essential constituents. These are often disguised under fanciful names and sold under extravagant claims and at exorbitant prices. As exam- ples may be mentioned: Cane sugar for curing tuberculosis (Hydrocine, Oleozone, Oxydase). Milk sugar for hay fever (Plantoxine). Epsom salt for "softening the skin" (Spurmax). Boric acid for deodorizing purposes (Amolin deodorant powder). About eighteen months ago the attention of The Journal was called to a preparation called "Jaroma," marketed by the Jaroma Company of New York City, and advertised to physicians as a specific for sleeplessness. The general tone of the reading matter indicated that Jaroma probably belonged to 192 PROPAGANDA FOR REFORM the same class of humbugs as Oleozone and Plantoxine. As the efforts of the promoters at that time appeared to be devoted more assiduously to the sale of Jaroma Company stock than to the exploitation of the remedy, it was not considered worth while to make an analysis of the preparation. Recently, however, an advertising campaign for the sale of the remedy has been inaugurated both in the lay and to a limited degree in the medical press. A quarter-page advertisement has been appearing in medical journals often supplemented by a "reader" which still further sets forth the supposed merits of the nostrum. In the advertisements in the daily papers the assertion is made that Jaroma is indorsed by the medical profession and in support of this, parts of the "reading notices" from the medical journals are quoted. Once more then we have the edifying spectacle of medical journals lend- ing their pages to the exploitation of a fraudulent "patent medicine" and aiding and abetting in humbugging the public. One medical journal which carries advertisements for this nostrum describes Jaroma in part as follows: * "A DISTINCT ADVANCE IN THE TREATMENT OF INSOMNIA "Recently a new hypnotic has become available to the profession and careful investigation seems to indicate that an ideal sleep- producer has been discovered. This new product, called Jaroma, is of vegetable origin and is obtained from a gum resin, in turn secured from narthex, a species of umbelliferous plant grown in provinces of Persia and Beloochistan. This gum resin from which Jaroma is prepared has long been used in the Orient for special purpose, while in Great Britain it has been successfully employed medicinally as an antispasmodic. "Through the use of Jaroma in appropriate dosage, natural sleep is obtained from which in four to eight hours a patient awakens refreshed and vigorous. No after-effect is produced and this eligible remedy is totally devoid of any depressing or toxic action. Its full physiological effect can be obtained as long as necessary without having to increase the dose and it has no habit-forming tendencies." The circulars accompanying the nostrum are evidently intended for the laity, as may be seen from the following: "Are you nervous? Take Jaroma Vegetable Tablets." "Can't you sleep? Take Jaroma Vegetable Tablets." "Jaroma Vegetable Tablets, the new & wonderful specific for the 'American Disease' Nervousness in its various forms." " . . Jaroma is the needed special nerve food to counteract the special strain of modern American business and social life." "For the discovery of the Jaroma formula we are indebted to an eminent German Nerve Specialist who has had most gratifying results from this compound in his private practice." Jaroma having gone to the medical profession its examina- tion was taken up by the Association's chemists who reported as follows: MISCELL A NEO US NO STR UMS 193 LABORATORY REPORT Narthex, the alleged source of Jaroma, is a nearly obsolete name for a genus of plants from some species of which the well-known drug asafetida is obtained. Physicians who are Photographic reproduction (reduced about one-half) of typical advertisements of Jaroma. On the left is the advertisement that has appeared in such medical journals as the International Journal of Surgery, American Medicine, Medical Council, American Journal of Clinical Medicine, and possibly others ; on the right is a typical newspaper advertisement. This particular one appeared in the •Buffalo Evening Times. familiar with the origin or sources of drugs will have little difficulty in recognizing this substance from the mysterious description given in the "readers" that appear in certain med- 194 PROPAGANDA FOR REFORM ical journals, while no one could fail in identifying it by breaking one of the Jaroma tablets! It is put up in tablet form in packages to be retailed at 10, 25 and 50 cents, the 10-eent size containing two and the 50-cent size twelve of the tablets. Qualitative tests demonstrated that the medicinal portion of the tablets consists of asafetida, calcium sulphate (gypsum) and powdered capsicum, the greater proportion consisting of the two former ingredients. The absence of hypnotic alka- loids, bromids and chloral was demonstrated and other hyp- notics such as diethyl-barbaturic acid (veronal) and sulphon- methane (sulphonal) were not found. Although no exact quantitative separations were made it is believed that a tablet containing asafetida 3 grains, gypsum 2 grains and capsicum 1/10 grain, would have properties similar to Jaroma. As gypsum has been frequently employed as an adulterant of asafetida the analyst has no means of demonstrating whether the calcium sulphate found in the tablets had been added as a "make-weight" or whether it is a part of the "formula" of the "eminent German Nerve Specialist." Thus according to the chemists' report this "new vegetable hypnotic" and "special nerve food" is, essentially, asafetida. Although in rational medicine no hypnotic powers are claimed for this drug it is often prescribed in certain forms of hys- teria, while as a condiment, it has been known and used from prehistoric times. Therefore, the only new thing about the stuff is its name and the fraudulent use to which asafetida is put. Jaroma is another of those nostrums which are used to humbug both the public and the medical profession.-(From The Journal A. M. A., Sept. 2, 1911.) KUTNOW'S POWDER Which is It, a "Proprietary" or a "Patent Medicine"? The term "patent medicine" has been applied, rather loosely, to those nostrums sold and exploited directly to the public, while the name "proprietary" has been given such prepara- tions as are advertised only to the medical profession. As has been many times exemplified by reports in The Journal. the distinction is often a very fine one and the dividing line frequently reaches the vanishing point. It is not unusual, for instance, for "proprietary" prepara- tions to be foisted on the medical profession until a certain number of testimonials (of doubtful value, it is true, but still MISU ELL AN EO US NO STU UMS 195 testimonials) have been ingeniously wheedled out of physicians and the product rather generously prescribed. When this ob- jective point has been reached the manufacturer comes into the open and advertises the nostrum to the public direct and the testimonials previously given for the "proprietary" are used as advertising assets for the "patent medicine.'' Then again there are certain preparations which are "pro- prietaries" or "patent medicines" according to the location. On one side of the Atlantic the product is advertised to phy- sicians only, while on the other side it runs indiscriminately on the billboards and in the newspapers. One of the best examples of this last class is Kutnow's Powder. In England, where it originated, this preparation which "dissolves and elim- inates uric acid," is consistently lined up with Beecham's Pills and Pink Pills for Pale People. Full-page newspaper advertisements announce the fact that free samples will be "SENT TO ALL APPLICANTS" In the United States, however, Kutnow's have learned from their wide advertising experience that a cheaper and surer way of introducing a nostrum to the public is to advertise it to the medical profession only. By means of advertisements in medical journals (whose space is much less expensive than that of the daily papers) and the liberal distribution of sam- ples which are "SENT FREE TO PHYSICIANS ONLY" the medical profession becomes the unpaid "barker" for the nostrum manufacturer. At present, therefore, Kutnow's Pow- der is-in the United States-an ethical (!) "proprietary." There exists in this country, as most of our readers know, an organization of "patent medicine" manufacturers whose "reason for being" is to get full value received for the $40,000,- 000 paid annually in advertising nostrums in the newspapers of the country. This organization is known as the Proprietary Association of America. The now familiar "red clause" in the advertising contracts by which the newspaper forfeits its contract if state laws are enacted that are inimical to the "patent medicine" interests, is a creation of this organization and has been most effective in making the newspapers the unpaid lobbyists of the nostrum interests. The "silence clause" 196 PROPAGANDA FOR REFORM is another ''joker" in the contracts by which the agreement is cancelled if matter detrimental to the nostrum "is permitted to appear in the reading columns" of the paper. It is little wonder that with such weapons the "patent medicine" manu- facturer has assumed an arrogance that is as disgusting as it is serious. Great Britain, too, has its "patent medicine" men's organiza- tion, which is known as the Proprietary Articles Trades Asso- ciation. Of both these honorable bodies Mr. S. Kutnow of Kutnow Brothers, Ltd., is, or was, a conspicuous member. At a recent meeting of the British organization, Mr. Kutnow worked himself into a fine frenzy of indignation because of some articles that had appeared in the Pharmaceutical Journal of London on the subject of "Secret Remedies and Proprie- taries." As these articles did not specifically mention Kut- now's Powder, and as evidence was directed against only those preparations as were most disreputable, it is evident that Mr. Kutnow now appraises his own product at its face value. He gave his opinion of the Pharmaceutical Journal and told the meeting that when the advertising man for that journal solic- ited advertising he refused to have any more dealings with him owing to the articles that had appeared in the Pharmaceutical Journal. He expressed himself as quite independent of any newspaper or journal, and able to take care of himself. MISCELLANEOUS NOSTRUMS 197 Therein Mr. Kutnow is mistaken; he is not independent of newspapers and journals. On the contrary, he, and others* of his ilk, are most subserviently dependent on them. Let rep- utable papers and medical journals refuse, for but one year, to carry the high-flown advertisements of his Anglo-American Patent-Proprietary, and his firm would perforce seek some worthier, if less profitable, line of business. The editor of the Pharmaceutical Journal resents Mr. Kut- now's "implied assumption that by inserting paid announce- ments in the advertising columns of a newspaper, he or any one else, can dictate the policy of that organ." The Pharmaceutical Journal, it should be said, is the official organ of the Pharmaceutical Society of Great Britain, and is the most influential organ of the drug trade in the British Isles. It is refreshing to note, in these days of "canned" editorials and paid "write-ups" masquerading as original arti- cles, that there is still to be found a journal that can not be bought. One wonders whether a large experience in the advertising world, and especially his membership in the Proprietary Asso- ciation of America, has unconsciously led Mr. Kutnow to assume that muzzling the press is one of the perquisites of the large purchasers of advertising space.-(From The Journal A. M. A., Aug. 31, 1907.) MANOLA Physicians as Unpaid Pedlers of Nostrums Evidently there must be a considerable number of physicians in the United States who sell themselves cheaply. Last week we printed in this department a description of a scheme that a St. Louis chemical company had for getting the doctors to work for them for very small pay. This week we have to record another St. Louis firm in the same delightful business. This scheme comes in the form of a triple postal card arrange- ment, on which the following liberal offer is made: Dear Doctor : In order to give you an opportunity to further test the properties of our MANOLA TONIC, we make you the following liberal propositions : Fill out the attached cards Nos. 1 and 2, mail No. 1 to US and hand Nos. 2 and 3 TO YOUR ' DRUGGIST. Upon receipt of the order for 1 dozen MANOLA TONIC from your druggist we will send with his order 3 full size bottles of MANOLA TONIC free of charge to YOU. Yours truly, THE MANOLA COMPANY. 198 PROPAGANDA FOR REFORM Card No. 1 is directed to the company, and the doctor is to fill in the name of his druggist, sign his name and put on the stamp. (The company ought to be willing to furnish the stamp.) On this card is this statement: Gentlemen :-I have this day accepted your offer through Mr. D ruggi st. Card No. 2 reads: Mr. Druggist: Please order of the Manola Company, St. Louis, Mo., 1 dozen MANOLA TONIC, all of which I agree to prescribe in my prac- tice. By filling out the attached card No. 3 and forwarding it to the above company, they will forward me, with your order, 3 full-size bottles MANOLA TONIC free for clinical purposes. Yours truly, - ■ ,M.D. In this instance the poor doctor either has to put this card in an envelope and put on a two-cent stamp, or carry it to the druggist himself. As he will probably be a cheap doctor in any event, he will no doubt save the two cents. Here is card No. 3: Date 19 MANOLA COMPANY, St. Louis. Gentlemen rPlease ship (me us), as per your offer, 1 dozen MANOLA TONIC at $8.50 per dozen. % dozen MANOLA TONIC free, for Dr. . (Signed) Druggist. Ship through my jobber. Here we have the doctor not only used as an unpaid pedler for a secret remedy, but also as a club to make the druggist fill up his shelves with the stuff. Of course, the three bottles the doctor gets for his labor are to be given to his patients, who will thus become acquainted with what the preparation is good for, and will then buy it direct. Certainly, it cannot get very much worse, unless the nos- trum manufacturers get the doctor to go on the street and peddle their stuff on a percentage.-(From The Journal A. M. A., May 6, 1905.) Manola Prescribing and Its Results Muscoda, Wis., July 31, 1908. To the Editor:-Enclosed is a copy of a letter sent to Dr. X. of Y., and his reply in the form of a marked advertisement of Manola clipped from a medical ( 1) journal. The style of MISCELLANEOUS NOSTRUMS 199 the advertisement sent would lead one to classify the product with "Peruna and the Bracers." The preparation was pre- scribed by Dr. X. for a Mr. Q. for a cough and "run-down" condition. Q. has been unable to do any work since he began taking it, but for three months he thought it benefited him, after which time he stopped taking it for three months and then took it again for five weeks. As he was emaciating rap- idly and was troubled with high fever and night sweats, he came to me, and I found him in an advanced stage of pulmon- ary tuberculosis. The patient had wasted nearly eight months of precious time, closely housed and depending on the restora- tive virtues of Manola, instead of consulting a physician at a time when a properly regulated out-of-door life might have saved him. And all because Dr. X. prescribed Manola to be taken for several months. Who is Dr. X. who did the prescribing? Polk's Register, 1906, records him as a graduate of a university in Germany; surgeon for the C., M. & St. P. Railway Company; member of the American Medical Association; member of the American Association of Railway Surgeons; member of the state his- torical society; medical examiner, etc. Shades of JUsculapius! This young man, now near death's door, asked me if Manola was not a good medicine, for, said he, "Dr. X., a very promi- nent physician, prescribed it to be taken continuously for a Ions time." And what could I, an insignificant doctor', reply? I said, "T don't know. I have not used it." And then T wished that I belonged to some other profession whose members are not "suckers" to bite at the bait of drug promoters and thus help them to fleece innocent persons while on • the road to chronic invalidism and death. C. R. Pickering, M.D. Comment: The above is only one example-a typical one, however-of the results of nostrum prescribing. The physician who in the above instance prescribed Manola-an old practi- tioner, over 70 years of age-when asked by another practi- tioner for information regarding it, has to fall back on an advertisement. This is what the advertisement says: New strength can be given to the failing heart, tissue changes arrested, and senile decay indefinitely postponed by the prescription of MANOLA which furnishes to the exhausted cell protoplasm the inorganic elements necessary for a renewed and increased activity, improves the quality and quantity of the blood, supports the heart, tones up the nerves, induces refreshing sleep, and checks the decline of mental and bodily vigor. Manola can be depended on in all cases of loss of strength and weight in old and young alike. A wonderful remedy, truly, that will do all this. Evidently Ponce de Leon in liis search for the fountain of eternal youth labored under the insuperable disadvantage of being born 400 years too soon. Had he but known, the fluid sought, which "indefinitely postpones senile decay" and "checks the decline 200 PROPAGANDA FOR REFORM of mental and bodily vigor" was to be found, not in the un- trodden wilds of Florida early in the sixteenth century but in the "laboratory" of a nostrum manufacturer four centuries later. Had this advertisement appeared in a newspaper and had one of Dr. X.'s patients consulted him regarding taking this "patent medicine"-for now it would be a "patent medicine"- he would most certainly have told the patient that it was fool- ish to believe such rubbish and not to waste his money on the stuff. And yet "Dr." Hartmann in his wildest flights of Peru- naese oratory has never transcended in mendacious assertive- ness the claims made for this "strictly ethical preparation." Three years ago we exposed the methods by which this nos- trum was exploited, and concluded: "Here we have the doc- tor not only used as an unpaid pedler for a secret remedy, but also as a club to make the druggist fill his shelves with the stuff . . . Certainly, it cannot get much worse, unless the nostrum manufacturers get the doctor to go on the street and peddle their stuff on a percentage." Manola illustrates another point: One of the curses con- nected with the nostrum business is the fact that many of the preparations are exploited by pseudo-pharmacal and pseudo- chemical companies. The Manola Company is reported as a side affair, and controlled by those who own the Luyties Homeopathic Pharmacy Company of St. Louis. What is the reason for creating a special company to exploit this nostrum? Is it because physicians might be prejudiced and not willing to buy from a homeopathic concern, or is it because the concern itself wishes to retain at least the outward semblance of decency ? The above case brings out another evil inseparable from nos- trums. While the great majority are useless and most of them innocuous, they do harm in a negative way. The lay- nian, depending upon the advertisements in the newspapers and believing what the advertisements state, takes a "patent medicine" and delays consulting a physician until too late. In the case of a physician, he, too, believes what the advertise- ment says, takes it for granted that he is doing what is right, neglects to study his case, to make a correct diagnosis, and to follow up the treatment by careful study of the case as it progresses. In a case like the above nothing can relieve the physician of his responsibility; he cannot fall back on the advertise- ment. In the case of the patient taking a "patent medicine," he depends on his own judgment. In the case in question, the MISCELLANEOUS NOSTRUMS 201 patient depended on one whom he believed knew what should be done. And the physician was false to his trust!-(From The Journal A. M. A., Aug. 8, 1908.) The Composition of Manola Inquiries have been received relative to the composition of Manola, a preparation manufactured by the "Manola Com- pany," said to be a subsidiary concern of the Luyties Homeo- pathic Pharmacy Company, St. Louis. Examination of Manola in the Association laboratory indi- cates that its composition is consistent with its origin, for its medicinal ingredients are present in truly homeopathic quantities. The laboratory report follows: An examination of an original bottle of Manola gave the following results: Specific gravity at 25 C 1.0329 Alcohol 18.00 per cent, by vol. Non-volatile matter (residue on evaporation) 15.93 gm. in 100 c.c. Ash ' .96 gm. in 100 c.c. Phosphoric pentoxid (P2O5) .0668 gm. in 100 c.c. Total alkaloids .0047 gm. in 100 c.c. Calcium Traces. Magnesium Traces. Iron Traces. Sodium Traces. Arsenic Traces. Manola is a light amber colored liquid having the odor and taste of sherry wine. The above analysis indicates that it is nothing more than wine, fortified with alcohol and a slight amount of medicinal substances added. The non-volatile matter appears to be nearly all sugar, glycerin, or some sim- ilar substance and the presence of less than one gram of ash to 100 c.c. excludes the presence of more than a small amount of organic salts. From the amount of phosphorus found there appears to be about one dose of phosphoric acid .to a twenty-ounce bottle. Arsenic is present in such small amounts that the ordinary hydrogen sulphid test failed to show its presence and the delicate Gutzeit's test had to be used to detect it. Some interesting points in regard to the methods of the exploiters of Manola appeared in The Journal, Aug. 8, 1908, p. 511; Dec. 19, 1908, p. 2172, and have been reprinted in the "propaganda for Reform."- (From The Journal A. M. A., April 2, 1910.) 202 PROPAGANDA DOR REFORM MARIENBAD TABLETS The Commercial Value of a Name What potentialities exist in a name! The great watering places and health resorts of Europe are household words and their names compel attention. Hence, when a physician receives in his mail a package bearing a foreign postmark and an unusual looking stamp, with the name "Marienbad" on the enclosure, he may possibly restrain his first impulse, born of experience, to throw the "sample" into the waste basket. He may be excused for expecting to find something of unusual merit in a medicine elaborated at such a world-renowned health resort as Marienbad. Especially is his enthusiastic expectancy pardonable when he learns that "Marienbad Tab- lets" are "prepared according to the prescription" of an individual with the imposing cognomen, "Prof. Dr. Med. Chevalier de Basch." Then, too, accompanying the "sample" is a circular descrip- tive of the virtues of this great medicine, printed in parallel columns of massive German and picturesque English. In it he is informed that the "Marienbad Tablets act mildly, with- out pain on the bowels, and consequently effect their evacua- tion." Great stress is laid on the advantage of the "tablet- shape" which makes possible the "offering of a perfectly equal dose of the efficacious ingredients" and simplifies the administration "on account of their compendious shape." "Marienbad Tablets," he is told, are unexcelled for the treat- ment of that condition recognized by all physicians as "sanguiness and its after-effects, such as vergitiousness," and they are highly recommended in cases of "arteriosclerose." As a sop to Cerberus, the circular suggests "the diagnosis should be made by the physician," the assumption being that the proprietors of "Marienbad Tablets" will take care of the treat- ment while the prognosis will naturally take care of itself. And the composition of this "compendious" cure for "san- guiness" and "vertigiousness"? Well, if carefully looked for, the physician will find that "Marienbad Tablets" consist of extract of aloes, powdered rhubarb, podophyllin, extract of cascara sagrada and extract of belladonna. That is all; just a simple cathartic tablet such as physicians are prescribing for their patients daily. They do not even contain a pictur- esque, pharmacologic nonentity like cactin or "latalia rad." Wherein, then, lies the special virtue of their "efficacious ingre- dients"? We are forced to the conclusion that this must reside in the psychic effect produced by taking a silver-coated MISCELLANEO US NO STR UMS 203 tablet from a gilt-trimmed box, labelled "Marienbad," rather than in the essential contents of the tablets themselves.- (From The Journal A. M. A., July 18, 1908.) MERCOL R. Hunt and A. Seidell, Washington, D. C., report the result of an examination of a preparation called Howell's Mercol, manufactured by H. B. Howell & Co., Ltd., New Orleans, and claimed to be a 1 per cent, solution of mercuric iodid in a non- irritating neutral menstruum, and recommended for hypo- dermic use in the treatment of syphilis. Their examination indicates, as they say, "that although the manufacturers of Mercol may have used a mercuric iodid in its preparation, they have not succeeded in obtaining a 1 per cent, solution of this compound in their 'non-irritating neutral menstruum.' It is furthermore evident that the sample examined as above outlined contains none, or at most, only traces of biniodid of mercury." It is stating it mildly to say that a manu- facturer is careless who claims to make an efficient prepara- tion of what is almost a specific for one of the most serious of diseases but which contains practically none of the essential active ingredient.-(Abstracted from The Journal A. M. A., Jan. 16, 1909.) The Component Parts and the Finished Product After the appearance of the first article, a physician wrote stating he had seen Mercol manufactured, following the process in detail and had himself weighed out a sufficient quantity of mercuric iodid to produce a 1 per cent, solution. He protested that the firm "had no desire to foist on the medical profession or the public a fraud." With his letter he sent a sample of the particular batch of Mercol which he had seen manufactured. This sample was analyzed with the same care and thoroughness that the previous sample had been, and the practical absence of mercuric iodid was again demon- strated. While The Journal does not question the honesty and good faith of either the manufacturers or the physician it maintains that claims for remedial agent should be based on the finished product rather than on the component parts used in its manufacture. Without attempting to explain what has become of the mercuric iodid, it insists that the important fact, and the one that vitally concerns both patient and physician, is that the finished product fails to contain it. If the manufacturer has made an honest mistake in supposing 204 PROPAGANDA FOR REFORM he could produce a 1 per cent, solution of mercuric iodid in liquid petrolatum, he will doubtless see that the mistake is corrected. If, on the other hand, he is governed by commer- cial considerations only, the misrepresentation will probably be perpetuated.-(From The Journal A. M. A., May 15, 1909.) NARKINE The Intangible Product of the Tilden Laboratory A little book, published by the Druggists Circular, and called "Modern Materia Medica," gives in dictionary form the information regarding new remedies which that journal pub- lishes in its monthly issues. Such information is not always acceptable to the manufacturers of various preparations of doubtful value. A case in point is brought to notice with reference to a remedy called Narkine, put out by the Tilden Company of St. Louis. In this little book the following appears: "Narkine is described as 'an opium preparation from which all deleterious qualities have been eliminated'; an unsupportable claim, as all opiates and other hyp- notics are essentially deleterious." The Tilden Company wrote to the Druggists Circular, stat- ing that they guaranteed Narkine "to be absolutely free from coal-tar or opium derivatives," yet the "literature" of the company describes it as "a specially prepared product of opium devoid of the nauseating and disagreeable properties of this drug, yet possessing the anodyne and soporific principles of same in the highest degree." To remove from opium all its derivatives and yet retain the anodyne and soporific principles attached to nothing in par- ticular, indicates a degree of pharmaceutical skill seldom at- tained. One is irresistibly reminded of the Cheshire cat in "Alice in Wonderland," whose smile remained long after the cat had vanished. The absurdity of the thing, however, has apparently not occurred to many physicians, for these disembodied spirits of the pharmacologic world are evidently being prescribed. The Druggists Circular is to be congratulated on exposing this latest pharmaceutical freak. It does so in a rather strik- ing manner by means of photographic reproductions of the claims of the Tilden Company.-(From The Journal A. M. A., Oct. 21h 1908.) MISCELLANEOUS NOSTRUMS 205 OXIDAZE-OLEOZONE-HYDROCINE In 1907, a "consumption cure" was put on the market under the name, Hydrocine. Hydrocine was called-at first- a "hyper-oxidized hydro-carbon;" later, it was referred to as an "oxidized carbo-hydrate." It was analyzed by the Associa- tion's chemists, who reported that they found that "each 29.5 grain Hydrocine tablet contains 28 grains of cane sugar and small quantities of volatile oils and a trace of pancreatin." This preparation seems to have originated with a C. E. Get- singer who organized what was known as the Medical Food Company. The commercial possibilities in selling an odorifer- ous sugar mixture as a "consumption cure" apparently appealed to one Charles S. Roberts, a physician of Syracuse, N. Y., who, with the help of Charles H. Goddard and others, incorporated the Hydrocine Company for the purpose of ex- ploiting Getsinger's "treatment." Goddard, it may be men- tioned in passing, was the man who organized that cooperative "patent medicine" concern known as the A. D. S.-American Druggists Syndicate. Getsinger and Roberts later seemed to have had a disagree- ment and Getsinger marketed his own product under the name of Oxydase. Roberts changed the name of Hydrocine to Oleo- zone and apparently had the stuff made by the A. D. S.-or at least it bore the same serial number as that given the A. D. S. products. Coincident with these changes in the name of the "hyper-oxidized hydro-carbon," another concern came into existence-the Cowles Institute, said to be operated by one H. L. Cowles. This also dispensed "oxygenated products" for the cure of consumption. A little later Cowles seems to have changed the name of his concern to the Hemavitse Com- pany and to have rechristened his product, Hemavitse. The latest change (March, 1911) in the name of Getsinger's product is Oxidaze put out by the American Oxidaze Company. This company claims to have purchased the formula of Get- singer who is no longer connected with the business. The concern is, if we are correctly informed, controlled by a group of business men; although one of the individuals con- nected witn it-Eugene Howard-is said to be a physician. The matter which follows is a reprint (slightly modified) of three articles that have appeared in The Journal of the American Medical Association, tracing the vicissitudes through which this odoriferous sugar mixture has passed in its various stages of evolution as a "consumption cure." 206 PROPAGANDA FOR REFORM Hydrocine We have, had occasion to comment on the diabolical cruelty exhibited by cancer fakers in deluding their victims with false hopes and by inducing them to delay such treatment as might be effective until too late. Next to cancer, tuberculosis offers the most promising field for such vampires, for it is a disease in which the patient is always hopeful and always ready to say that he is better; just such a condition as makes him an easy victim for those who are without principle and ready to prey on the hope which springs eternal in the human breast. During the past three months1 physicians all over the coun- try have been receiving postal cards announcing the discovery of a new and wonderful remedy for consumption. The card Photographic reproduction (reduced) of a post-card sent out by C. S. Roberts at the time he first began exploiting Hydrocine. Notice the claim that his nostrum is a "positive cure of tuberculosis of all forms." Note, too, the way in which Roberts made capital out of his membership in the Medical Society of the State of New York and in the American Medical Association. Roberts joined the American Medical Association in December, 1906, just before he went into the "consumption cure" business. In September, 1907, the county society repudiated him and his membership in the state and national organizations was thus automatically terminated. is signed, "C. S. Roberts, M.D., Member N. Y. State Medical Society and American Medical Association." It is to be re- gretted that what Roberts says regarding his membership is true. Until within the last few months Roberts lived at Syra- cuse, N. Y., and is a member of the Onondaga County Medical Society and consequently of the Medical Society of the State of New York. Last December he became a member of the American Medical Association. This was just before his re- 1. This was written in August, 190". MISCELL A NEOUS NOSTRUMS 207 moval to New York City, and lie evidently obtained this mem- bership because he was going into this wretched business and wanted to use his membership as apparent guarantee of his ethical standing. As soon as the Onondaga County Medical Society discovered the business Roberts had gone into he was asked to resign, but this he refused to do. Hence it became necessary for the society to go through the legal form of trial before expelling him from the society. We understand that his trial cannot come off until September, and that Roberts is fighting to retain his membership.2 According to the postal card, Roberts is just commenc- ing to introduce to the medical profession "(on strictly ethical lines)"-this is put in parentheses probably for empha- sis-"a positive cure for tuberculosis in any form." "This dis- covery," he says, "is the result of fourteen years scientific study and experimentation," but so far as we have been able to learn, Roberts has not been noted as performing any remark- able cures of tuberculosis in Syracuse, nor was it known that he was using this wonderful remedy. The last paragraph of the postal card is supposed to be a clincher: "Doctor, a trial will prevent your tubercular patients from saying your neighbor doctor is curing his patients in a few weeks right at home, while you are sending them at great expense in time and money to remote resorts for consumptives." Judging from the circulars, Roberts seems to have gone to New York to help exploit a nostrum-Hydrocine-put out by the "Medical Food Co.," and evidently the postal card is the initial move in a scheme to exploit the medical profession. Incidentally, it might be said that some two or three years ago Roberts was interested in a scheme to work the doctors by getting them to invest in a water still, and the circular letters he sent to physicians at that time sound very similar to the circulars he is now sending out puffing this specific for consumption. In one of the "still" letters he states that he made $3,200 in less than two months on an investment of $300. Evidently something must have happened to the "still" business, for such a man would hardly give up a business net- ting $2,900 in two months, even to exploit a remedy that is to relieve the human race of one of its most fatal diseases. The recipient of the postal card above referred to is told that if he will send 15 cents in postage stamps he will be fur- nished with the "theory, literature and abundant testimonials and a $3 size sample to prove what we say." This part of the 2. He was dropped at the September, 1907, meeting. 208 PROPAGANDA FOR REFORM agreement is lived up to. The theory is furnished, plenty of literature, including testimonials, and also a box of the tab- lets. The theory ought to take with an ignorant layman, and the literature certainly is promising and hopeful enough to convince the most desperate individual that he could be cured. Photographic reproduction (reduced) of a circular letter sent out by Roberts at the time that he was trying to get physicians to invest in the "Automatic Water Still." The physician to whom this letter was addressed said : "This is the third letter I have received from Dr. Roberts in the past few weeks, none of which I have answered." The wonderful remedy is known as Hydrocine-hyper-oxi- dized hydro-carbon. The circular tells us that "the physician is unquestionably entitled to a full, frank and candid state- MISCELLANEOUS NOSTRUMS 209 ment of the composition, nature and character of any and every medicinal preparation he is asked to prescribe." This sounds excellent, and then follows the formula: FORMULA Hyper-oxidized hydro-carbon (vegetable) 28 gr. Pure rock sugar 8 gr. Powdered pancreatin 1/20 gr. The oxids are liberated in the stomach and thrown into the circulation. Photographic reproduction (reduced) of the 'letter-heads of some of the various concerns that have found it profitable to exploit an odoriferous sugar mixture as a "cure" for consumption. It is barely possible that there is somebody on this mun- dane sphere that can tell what "hyper-oxidized hydro-carbon (vegetable)" is. Most of us have a knowledge of pure rock sugar and powdered pancreatin, but when we come to the other ingredient, we fear the majority of us would have to give it up. However, we find this in the printed circular: The hydro-carbon is extracted from oils of cinnamon, coniin, peppermint, spruce, myrtle, chekan, marrubium, myrrh, turpen- tine and thymol, is then condensed, and positively all toxic properties are eliminated. The residue is hyper-oxidized, pre- digested by pancreatin, mixed with a small quantity of pow- dered rock sugar and pressed into 30 grain tablets. 210 PROPAGANDA FOR REFORM There we have it. And when we have it, what have we? The literature is of the usual quackish order, the optimistic kind that will make the physician who does not stop to think feel that it is something worth trying at least. TESTIMONIALS AS USUAL Of course, there are testimonials-several of them. What nostrum was ever introduced, whether to the public or to the profession, that did not have testimonials ready? Many of the testimonial givers we have not located, but they may be genuine for all that. One who speaks in high praise of the nostrum is Dr. 0. P. Barber of Saginaw, Mich., who is given as "professor of surgery, Michigan College of Medicine and Surgery, Detroit, Mich." Dr. Barber's success is really remark- able when it is considered that he disregarded Dr. Roberts' instruction to select an incipient case, for he seems to have taken one with extensive cavities, in the third stage, a man with undoubted complications, whose sputum was so offensive that the doctor asked him to expectorate in the closet in the next room. He also neglected to give a "good liver cathartic at the start," as the circular advises, but put him at once on hydroeine. Possibly Dr. Barber did not carry out the full instructions because he did not get them from the right source, for he tells us that he was led to use the remedy on the advice of a layman, from whom he seems to have obtained his early supplies. However, notwithstanding these palpable vio- lations of the correct method of using the preparation, this unpromising patient recovered to such an extent that the cavi- ties all filled up and over 40 per cent, of the patient's lung consists of scars. This was proved by the <r-ray. Dr. Barber had other equally remarkable cures. Another name that is often seen in a certain class of litera- ture appears in connection with this Hydroeine. This is Dr. J. W. P. Smithwick, of LaGrange, N. C. Dr. Smithwick, how- ever, is given to writing very favorably of preparations that are not in the Pharmacopeia, such as Glycobenphene, Boroben- phene, Tongaline, Bromidia, Maltopepsine, Ecthol, Phenalgin, Dermapurine, Angier's Petroleum Emulsion, Thialion, etc., for we find his testimonials in the advertising literature of all of these articles. Dr. Smithwick, who, by the way, is given as "first vice-president of the American Congress on Tubercu- losis," and therefore should be an authority on the subject, seems also to have had a most notable experience, for every patient treated recovered, and his cases included not only pul- MISCELLANEOUS NOSTRUMS 211 monary tuberculosis, but also hip-joint disease, lupus vulgaris, etc., and of the worst sort. When we began to receive Roberts' postal cards and were asked to show up the scheme, we thought the card itself was so quackish that no intelligent physician would risk even the 15 cents. It seems, however, that some have been "almost persuaded," and we have been astonished to receive letters asking if it is not possible that this nostrum may do what its promoters say it will do, evidently feeling that possibly, after all, the long-looked-for remedy has been discovered. How foolish! If Roberts and the promoters (who are, perhaps, making him a cat's paw) really had a remedy that would do what they claim this one will do, there would not be words in the English language strong enough to characterize their vil- lainy and inhumanity in keeping it secret. If, on the other hand, the stuff is a fraud, then it is simply another instance to add to the list of attempts to humbug the public, and to make money out of their suffering. Either horn of the dilemma is certainly reprehensible, and to have one who is supposed to have once been a reputable physician mixed up in it should be a source of regret to every member of our profession. (From the Journal A. M. A., Aug. 17, 1907.) An Analysis of Hydrocine Hydrocine, widely advertised as a consumption cure and belonging to the class that Samuel Hopkins Adams would designate the "fundamental fakes," has been analyzed by our chemists and found to consist chiefly of cane sugar. In common with other members of its class, it is advertised as being an essentially non-secret preparation and, to bear out that claim, an involved and meaningless "formula" is appended. Its promoters state that Hydrocine is "a vegetable hyper-oxi- dized hydro-carbon"-whatever that may mean. Its "formulas" are equally enlightening. We use the plural advisedly, as Hydrocine exhibits that fine fickleness and mutability of com- position that characterizes nostrums of its kind. Its early "formula" was as follows: Hyper-oxidized hydro-carbon (vegetable) 28 gr. Pure rock sugar 8 gr. Powdered pancreatin 1/20 gr. The oxids are liberated in the stomach and thrown into the circulation. For some unknown reason, however, this "formula" was changed before the edition of the pamphlet, setting forth the wonders of the combination, was exhausted. "Formula" No. 212 PROPAGANDA FOR REFORM 2, as printed on a "sticker" placed over "Formula" No. 1, states that Hydrocine consists of: Oxidized carbo-hydrates and essential oils '18 1/2 gr. Mineral constituents 1 1/2 gr. Pure rock sugar 9 gr. Powdered pancreatin 1/20 gr. Accompanying this later pamphlet-or more correctly, the earlier pamphlet with a later "formula"--is a circular giving the following enlightening information regarding the compo- sition of Hydrocine: INGREDIENTS "Oil of cinnamon, coniin, peppermint, spruce, myrtle, chekan, marrubium, myrrh, turpentine and thymol, with all toxic prop- erties positively eliminated. The residue is highly oxidized, mixed with oxidized sugar, pancreatin and pressed into a 30 grain tablet. The oxygen is liberated in a nascent form and taken up by the circulation, and thus enables patients to become saturated with the same in 30 minute doses." This same circular also gives what purports to be a report of an analysis of Hydrocine Tablets, which, however, reads more as if it were a testimonial prepared at the request of the manufacturer, in spite of the fact that it is written by a pre- sumably reputable chemist. Thus, while the report states that the tablets contain a certain amount of "aldehydes, ketones and oxidized products from the bodies used," the chemist virtually acknowledges that these bodies were not actually determined by him. In fact, from the language of the report one is led to believe that he accepted the manufacturer's state- ment in regard to their presence. Of course, we do not know the composition of the Hydrocine which the manufacturer sub- mitted to this chemist for report, or the composition which Hydrocine will have in the future. The report of the analysis made for the American Medical Association by its chemists indicates the composition of Hydrocine such as is sent to physicians, and is, therefore, of interest. It is as follows: RESULTS OF ANALYSIS We have made a careful examination of the original package of Hydrocine and find that the average weight of the tablets is 29.5 grains. Of this, 95 per cent., or 28 grains, of the total of 29.5 grains, is cane sugar. Each tablet contains an average of 0.3 of a grain of a sub- stance, insoluble in alcohol, containing nitrogenous matter. The indications are that this substance may be very impure pancreatin, chat is, that this 0.3 of a grain may contain the 1/20 grain of pancreatin MISCELLANEOUS NOSTRUMS 213 claimed to be present by the manufacturers. It also contains very small quantities of aromatic oils', and it is probably due to the fact that these oils, like tur- pentine, react with oxygen that it is claimed that the vegetable matter is "hyper-oxidized." The formula, however, mentions "hyper-oxidized hydro-carbon." Perhaps the manufacturers have reference to the rock sugar and mean carbohydrate, for there is probably no oxidation of the sugar, though it is probable that the aromatic oils present may be partially oxidized and changed in other ways after a time, but the "hyper- oxidized hydro-carbon (vegetable) 28 grains" of the Photographic reproductions (reduced) of some advertisements of the various sugar "cures" for tuberculosis. The advertisement of Hydrocine appeared in the Texas Medical Journal; that of Oleo- zono, in the Medical Summary ;■ that of Oxydase, in the Interna- tional Journal of Surgery. formula is an absurdity, particularly as the analysis shows that the tablet contains 28 grains of sugar. We do not believe that it is possible for such a substance as turpentine, for instance, when in contact with sucrose (cane sugar) to act as an oxidizing agent. Apparently, therefore, the essential constituent of Hydro- cine, as it is now offered to physicians, is cane sugar, and evidently this was the substance which was referred to as the "hyper-oxidized hydro-carbon." As indicated by our chem- 214 PROPAGANDA FOR REFORM ist's report, the very learned (?) statements regarding the "hyper-oxidized hydro-carbon" or "oxidized carbo-hydrates" may be reduced to a simpler statement: "Each 29.5 grain Hydrocine tablet contains 28 grains of cane sugar and small quantities of volatile oils and a trace of pancreatin." SUMMARY To sum up, we have: A preparation, shown by analysis to be 95 per cent, cane sugar, put on the market to be retailed Photographic reproduction (reduced) of the cover page of a small booklet in which a Dr. W. H. Morse fulsomely lauds Roberts' product. This write-up was also published in several of the less reputable medical journals. Morse seems to make a busi- ness of furnishing write-ups for various medical fakes. Epilepsy cures, rheumatism cures, cures for blindness and vibrators are but a few of the things that Morse has testified for. The letters "F.S.Sc. (London)," that appear after his name, indicate that he is a member of a serio-comic, fraudulent concern calling itself the "Society of Science, Letters and Art." The cost of obtaining the honor (?) of membership in this "society" is $5.00. MISCELLANEOUS NOSTRUMS 215 at a cost of $8 a pound (avoirdupois). The claim is made that hy giving this preparation in 30-grain doses to the extent of one and a quarter ounces daily, tuberculosis can be "per- manently cured" in "from six to sixteen weeks." To impress the unthinking, the main constituent in the formula is given a quasi-scientific name, meaningless in import. The exploiter of this "remedy" claims to have given up a practice yielding $10,000 annually "to spread the truth regarding this prepara- tion"-and incidentally, we suspect, to reap the benefits that must accrue from selling sugar at over $5 a pound, wholesale. Our chemist having translated for us into simpler language the statements as to the composition of the article, we, as physicians, should not find it difficult to interpret correctly the evidence on which the claims are based. (Modified from The Journal A. M. A., Feh. 15, 1908.) Oleozone-Oxydase-Cowles Institute Hydrocine is no more, but the commercial possibilities in sugar as a therapeutic agent are still recognized. Phoenix-like, there have arisen from the ashes of Hydrocine two other "hyper-oxidized hydro-carbons"-Oxydase and Oleozone. In fact, there seems to be at present no fewer than three con- cerns which are "curing" tuberculosis by means of sugar plus various incidentals. HYDROCINE-OLEOZONE-OXYDASE Before Dr. Roberts "gave up a practice that was yielding . . . [him] an income of over $10,000.00 a year" to sell odoriferous sugar at $8.00 a pound, Hydrocine seems to have been manufactured by a Mr. E. C. Getsinger. It now seems that Getsinger and Roberts have parted company, for the country is being flooded with letters from Roberts in which he says: "In view of the fact that the party [Getsinger?] who formerly manufactured the old product for me . . . is now attempting to market it himself, I wish to avoid the danger arising from anyone confusing it with my improved treatment. For this reason I have adopted a new name, Oleozone (oil and oxygen), and under this title my new and vastly improved product will be marketed." On the other hand Mr. Getsinger, who signs himself pro- prietor of the "Oxydase Company," and who, apparently, is the Oxydase Company, has attempted to checkmate Dr. Rob- erts by means of post-cards and other advertising matter. He says: Photographic reproduction of two labels, one from the "headache cure" put out by the A. D. S., the other from the "consumption cure," Hydrocine (now called Oleozone), exploited by C. S. Rob- erts, one of the original directors of the A. D. S. Notice that the serial number on the two labels is the same, indicating a common source. MISCELLANEOUS NOSTRUMS 217 "The chemical name of the compound is 'oxydized hydro-carbon' and later it was named 'Hydrocine.' In the present perfected form we present it to the profession under the name 'Oxydase.' " . That there may be no mistake, the Oxydase Company sends out a printed post-card which begins: "Dear Doctor :-This informs you that Dr. C. S. Roberts of New York is no longer the sales agent for Hydrocine." BRINGING TESTIMONIALS UP TO DATE The advertising "literature," including testimonials of the apparently defunct Hydrocine Company, seems to have re- verted to Mr. Getsinger, as the Oxydase Company's pamphlets are practically a re-hash of the old Hydrocine matter. In this connection, it is interesting to note how testimonials are over- Photographic reproduction (reduced) of a postal card sent out by Getsinger after his break with Roberts, in which he calls attention to the fact that Roberts is no longer the sales-agent for Hydrocine. It was at this time that Getsinger rechristened his product Oxydase. In the original card the words "Hydrocine is now called Oxydase" were imprinted with a rubber stamp over the picture of the shell of hydrocine. Most of this is lost in the photo- graphic reproduction here given. worked. One of the most imposing testimonials in the old Hydrocine pamphlet was that accredited to Dr. 0. P. Barber of Saginaw, Mich. In this testimonial, Dr. Barber was quoted as saying: "I was looking for a case to try Hydrocine on, which Mr. George B. Morley, President Second National Bank, had brought home with him from New York, and was furnished me by him for nearly all the cases 1 have treated." 218 PROPAGANDA FOR REFORM He then came to see me, at my request, as 1 was looking for a case to try hvdrocine on. which .Mr. George B. M or ley, President Second National Bank, 'had ' brought home with him from New York, and was furnished me by him for nearly all the cases I have treated. His condition was such that I had no hopes whatever of helping him with any remedy, but Mr. Morley had so excited my curiosity regard- ing 'this remedy by his description of cases he had talked with in New York, alleged to have been cured by'this treatment, that I put him on the medicine. 1 > He then came to see me, at my request, as I was looking for a case to try Hydrocine on, which Mr. George B. Morley, President Second National Bank,"had brought home with him from New York. l^r.. Morley had so excited my curi- osity regarding .this remedy by his description of cases he had talked with in New York, alleged to have been cured by this treatment, that I put hirii on the medicine. 2 He then came to see me, at my request, as I was looking for a case on which to try the Getsingcr treatment, which Pr. George B. M, had brought with him from New York. ' fe . M. had so ex- cited my curiosity regarding thTTremedv by his / description of cases he had talked with in New] York, alleged to have been cured by this treatment, J that 1 put Goldsmith on the medicine. j ^wJIis^im^rapc£LUgas__marked inthe -extremey^ 3 The evolution of a testimonial. From the Goldsmith Case credited to Dr. O. P. Barber: 1, As it appeared in the earlier Hydrocine pamphlets; 2, from the later Hydrocine "literature"; 3, as it is now in the Oxydase pamphlet. MISCELLANEOUS NOSTRUMS 219 We called attention in our previous article to the somewhat unusual course of a physician administering a remedy of whose virtues he learned from the layman who furnished it. This objection cannot be raised, however, to this same testimonial of Dr. Barber's as it now appears in the Oxydase "literature." While it is used practically verbatim, except for the substitu- Photographic reproduction (much reduced) of a newspaper adver- tisement of Oxidaze, the latest name for Getsinger's product. This stuff is now being sold direct to the laity. tion of the term "Getsinger treatment" where "Hydrocine" used to appear, we find that the erstwhile bank president has assumed a professional rdle, and that "Mr. George B. Morley" has become "Dr. George B. M." We are loath to believe that a bank president would give up his highly reputable and not PROPAGANDA FOR REFORM 220 unlucrative business for the purpose of developing the thera- peutic possibilities of rock candy-even though there may be money in it. Knowing what we do of testimonials and their value, it seems more reasonable to suppose that the trans- formation of the banker into a physician is merely an artistic touch on the part of those who adapted the Hydrocine adver- tisements to the Oxydase product. THE NEW CHEMISTRY Much stress is laid by the Oxydase Company on the state- ment that while their tablet is super-oxidized, the substitute tablet [Oieozone?] "is not oxidized." To prove (?) their point, the Oxydase Company says: "Place the tablet between tweezers, ignite with a match, then observe the oxygen blue flame. The sputtering is the explosion of small quantities of Oxygen as it is rapidly liberated. There is no smoke, nor odor, proving complete combustion." [Italics ours.-Ed.] This test, both from theoretical and practical considerations, deserves notice. Theoretically, because oxygen being, in air, an incombustible gas, can neither explode nor burn with a blue or any other kind of flame; practically, because, the statement to the contrary notwithstanding, there was some smoke and a distinct odor of burning sugar when a sample Oxydase tab- let was ignited. The "oxygenating" power of Oxydase and its varied thera- peutic indications are set forth in the following weirdly con- structed sentence: "With 20 remedial impulses in septemia within ten hours, or longer on the same dosage, is a formidable weapon in the hands of a physician-in cases of Typhoid Fever, and other sudden invasions of disease; in Croup, Pneumonia, Diphtheria, Asthma, Abscesses, Bronchitis, etc., Oxydase will give you surprising results." OLEOZONE "'STRICTLY ETHICAL" In calling attention to his "improved Hydrocine," Dr. Rob- erts emphasizes that he is "distributing this remedy along strictly ethical lines only." In fact, he "will not even place it in drug stores, unless to accommodate a physician at his request." This course is somewhat of a departure from that which he followed in exploiting Hydrocine. THE "COWLES INSTITUTE" But Dr. Roberts and Mr. Getsinger are apparently not the only ones who dispense "oxygenated products." We have received letters from various parts of the country inquiring about a New York concern calling itself the "Cowles Insti- MISCELLANEOUS NOSTRUMS 221 tute." A pamphlet sent out by this "institute" has printed on the cover a red double-cross-a misuse of the international emblem of the campaign against tuberculosis that is as unwar- ranted as it should be illegal. On the title page we read: "Established for the treatment of tuberculosis in its various forms by entirely new and special methods of medication complying with the highest ethical standards, by which full recoveries in uncom- plicated cases of tuberculosis are generally made in from six to nine months without the necessity of changing climate or enforcing severe or rigid hygienic-dietetic rules." A SUBTLE REMEDY The "entirely new and special methods of medication" is "by means of an easily digested specially oxygenated product that by regular process of assimilation conveys Atomic Oxygen in proper combination direct to the circulation. . . ." This wonderful remedy is far too subtle a product to dis- tribute indiscriminately to the medical profession, much as the Cowles Institute would like to do so, "but owing to the necessity of keeping it under fixed conditions of light and temperature and of using it within a very limited period of time in order to obtain the proper results, it is manifestly impos- sible to do this." We find, however, that the "treatment" is not to be entirely "cornered," as letters are sent to physicians stating that it is the desire of the "institute" to place the "oxygenated product" in the "hands of at least one competent physician in every community of consequence." To those physicians who have a tuberculous patient under their care, they would "be glad to send a sufficient quantity to demonstrate its value without any expense except express charges." As to what may be expected from this "treatment," the modest claim is made: ". . . practically 90 per cent, of the cases we take in the first and second stages of tuberculosis make a complete and apparently permanent recovery." We have, then, apparently three concerns "curing" tuber- culosis by means of sugar and essential oils, two of them operated by laymen. The similarity of the claims made, and of the methods pursued, by this trio of "consumption cures" is best shown by the quotations (Page 222) we have taken from the "literature" and correspondence of the three con- cerns and arranged in parallel columns.- {From The Journal A. M. A., Mar. 20, 1909.) ROBERTS TREATMENT (OLEOZONE) "Oleozone is prepared from the oxy- genated principles of the oil of cassia, coniin, peppermint, spruce, myrtle, myrrh, marrubium, turpentine and thymol . combined with rock candy, sugar and pan- creatin. . y "It purveys a constant supply of oxygen to the blood. . ." . a harmless compound positively not injurious from prolonged use." "Drink no water within fifteen minutes before or after taking the tablets, as water disturbs the oils in the tablet." "Soon twinges of pain and great soreness in the chest may be noticed, with perhaps tinges of blood in the sputum." ". . . this new treatment requires only six to sixteen weeks to perfect a per- manent cure. . ." ". . . the party who formerly manu- factured the old product for me ... is now attempting to market it himself. I wish to avoid the danger arising from any- one confusing it with my improved treat- ment." "In cases of acute Pneumonia it will cure them so quick that it will surprise you." COMPARISON OF CLAIMS OF THE TRIO OF CONSUMPTION "CURES" GETSINGER TREATMENT (OXXDASE) "Oxydase tablets contain Oils of Winter- green, Cinnamon, Peppermint, Coniin, Sas- safras, Thyme and Turpentine and Sugar, all highly oxidized." "Oxydase is . . . a prolific oxygen- ating agent in medicine. . ." ". . . no toxic dose possible. . ." "Have patients drink milk at any time, but not so with water, which decomposes the tablet . . . causing cumulation and nausea." "Twenty days thereafter . . . dull, twinging pains over infiltrated areas; tinges of blood in sputum." "Course of treatment lasts from six to twelve weeks." "There are substitute hydro-carbon treat- ments now being exploited which are not an oxidized product." "In . . . Pneumonia . . . Oxydase will give you surprising results." COWLES TREATMENT ". . . composed of a base ■ of saccha- rum and two enzymes, one gastric and the other pancreatic. To this ... is added the highly oxygenated active princi- pal [sic] of the essential oils of thymus, terebinthina and eucalyptus with chlorophyl and aromatics." ". . . a safe, feasible method of rap- idly furnishing the blood with the necessary oxygen properly combined. . "It is non-toxic. . ." "Instruct patient to avoid taking water within fifteen minutes before or after tak- ing a tablet, as water in some cases, com- bined with the oils in the tablets, produce slight nausea." ". . . during the first week of treat- ment . . . the sputum may be tinged with blood and the patient complain of slight shooting pains or tingling sensations throughout the infected areas." . . full recoveries in uncomplicated cases of tuberculosis are generally made in from six to nine months. . ". . . the oxygenated products em- ployed in our treatment . . are unob- tainable elsewhere. . . Neither are they similar in characteristics or action to any other so-called oxygenated products that may be on the market." "In Pneumonia we find this tablet un- doubtedly a specific for this disease." MISCELLANEOUS NOSTRUMS 223 PAPINE A Disguised Morphin Solution To the thinking physician it should be evident that a prepa- ration containing morphin must possess not only all of the valuable properties of this drug, but also all of the objec- tionable ones. There are still some physicians, apparently, who give credence to the assertions of the manufacturers con- cerning a morphin preparation from which, it is claimed, all of the undesirable morphin effects have been removed. The following query from a correspondent illustrates this fact: "Will- you inform me as to the contents of "Papine"? I have a case of chronic interstitial nephritis, and my consultant insists on giving this preparation. I asked him if he knew what drugs it con- tained and his answer was 'one-eighth of a grain of morphin with the objectionable parts of the drug -removed.' '' The query was referred to the Association Laboratory, which submitted the following report: For many years Papine has been advertised by its makers. Battle & Company, St. Louis, as an anodyne. In the cir- culars Papine is described in part as follows: "Papine represents in pharmaceutical form the purely anodyne principles of opium freed from the narcotic and tetanising constit- uents." "Papine is the anodyne or pain-relieving principle of opium, the narcotic and convulsive elements being eliminated. One fluid drachm is equal in anodyne power to one-eighth grain of morphin." "Through special methods of preparation, the anodyne and analgesic principles of Palaver somniferum are so extracted as to free .them of the narcotic and convulsive elements that ever have been, and must ever continue to be serious objections to the use of opium and its common derivatives. . . . No demand is more regularly made on the physician than that for the relief of pain, and to be able to afford it promptly and completely, without the slightest deleterious action, is an advantage that cannot be overestimated." "Unlike most derivatives and preparations of opium, Papine neither nauseates nor constipates; nor does it inhibit the secretory functions of the body." "In conditions of extreme nervousness, especially in women, recourse to morphin is attended by the very real danger of the formation of a habit. Lastly, opium and its alkaloids must not be administered to persons whose kidneys are not in good working order on account of the risk of toxic accumulation." "No such restriction exists in respect of Papine, its action being exerted exclusively on the element pain; in other words, it is purely anodyne." "Papine does not nauseate, constipate nor create a habit." 224 PROPAGANDA FOR REFORM From these statements the incautious physician might be led to infer that Papine is a preparation analogous or similar to the official tincture of deodorized opium. Formerly in the manufacture of the latter preparation, in addition to removal of the odorous substances, narcotin, then thought to be the principal convulsive alkaloid,1 was also removed. By the process for the manufacture of this tincture, which is now official in the United States Pharmacopeia, most of the narco- tine is found in the finished preparation. While it is a com- paratively simple matter to remove the narcotin from opium and its preparations, thus eliminating most of the commonly reputed "convulsive elements,"2 to remove the "narcotic ele- ments" from opium would result in destroying the integrity of the product. The reasons for this are that morphin is the The Papine label before (on left) and after (on right) the passage of the Food and Drugs Act. And the exploiters of this morphin solution have the effrontery to claim that it does not create a habit! most powerfully narcotic substance found in opium, and it is present in the largest proportion of any of the alkaloidal constituents. Its removal from an opium preparation would, therefore, render that preparation practically valueless. From Papine, however, the morphin has not been removed, for since the passage of the Food and Drugs Act the label has to admit that Papine contains 1 grain of morphin in each ounce! A specimen of Papine was examined and found to be noth- ing more than a simple aqueous-alcoholic solution of morphin, containing glycerin. The preparation is flavored to imitate cherry and colored with cochineal. With the exception of 1. Narcotin is now known to possess very little physiologic effect. 2. Of the opium alkaloids, laudanin and thebain possess the most powerfully tetanizing properties, but they are present in opium in too small quantities to produce any noticeable effect. Neither of these alkaloids is removed by the usual processes for "denarcotizing" opium. MI SCELLA NEO US NO STR UMS 225 morphin, neither narcotin, codein nor other opianic alkaloids were found, while meconic acid, a characteristic constituent of opium, was absent. Since Papine is claimed not to cause constipation, and as is well known, this condition is frequently produced by morphin, it seemed possible that Papine might contain laxative substances. On examination, however, neither cascara, rhubarb, phenolphthalein nor laxative salts were found. While Battle & Co. have persistently exploited Papine as being an opium preparation having none of the objectionable qualities of opium, the analysis shows that the paradoxical claims made for it cannot be substantiated. In prescribing morphin there is an abundance of official preparations to choose from, and there certainly is no necessity or excuse for resorting to the much more expensive and in no way superior Papine.-(From The Journal A. M. A., April 29, 1911.) PAS-AVENA How Its Formula Evades the Food and Drugs Act Pas-Avena is a widely advertised "nerve sedative and hyp- notic." The preparation is put on the market by the Pas-Avena Company of New York City. As a headliner the advertise- ments of the remedy state that the formula has always been on every bottle, and this, The Journal states, has a twofold object: It aims to give the impression that the preparation is non-secret, and it is calculated to inspire confidence in the- apparently-scientific nature of the product. As a matter of fact, it should do neither. The preparation is essentially secret in its composition because of the presence in the formula of an unknown quantity and the liability to change of formula at the whim of the manufacturer. On the bottles some time ago the following formula was given: Each tablesspoonful contains: Passiflora ....20 minims. Avena sativa 10 minims. Somnalgesine (C3oH»8NB00) 2 grains. The first two ingredients are plants in whose therapeutic value but little confidence is placed. Somnalgesine, the third constituent, is a secret preparation, the chemical formula of which the manufacturers were kind enough to add. To a chem- ist, however, the formula is absurd and impossible, and is included either because of the manufacturer's ignorance or because of an intent to deceive the profession. Since the Food 226 PROPAGANDA FOR REFORM and Drugs Act became law, the label of Pas-Avena has been changed to read: Alcohol 8.37 per cent, by volume. Anilipyrine. . - 16.00 grains per fluid ounce. Guaranteed under the Food and Drugs Act of June 30, 1906. Substitution of anilpyrine for somnalgesine gives little more information. Chemists may recognize this as a name applied to a mixture said to be formed by the fusion of two mole- cules of antipyrin and one molecule of acetanilid. To physi- cians, however, the name carries with it the same mystery as did somnalgesine. Attention is directed to the fact that by publishing the guarantee under the pure food laws the com- pany presumes to disperse all doubt and criticism, assuming that the majority of physicians will be satisfied with the guarantee as it stands. Inasmuch as the preparation contains acetanilid and antipyrin, however, the manufacturers are disregarding that part of the Food and Drugs Act which requires that the name of the parent substance-in this case acetanilid and antipyrin-be put in parenthesis. The laws are so well defined that physicians appear to be content to do nothing, firmly believing that they are safe from the defraud- ing methods of unscrupulous manufacturers.-(Abstracted from The Journal A. M. A., March 7, 1908.) PEPTO-MANGAN (GUDE) Scientific Work Misrepresented and Commercialized In this article the misuse by the exploiters of pepto-mangan of the government report on anemia in Porto Rico is exposed. The conclusion of the government commission, which investi- gated the anemia prevalent in Porto Rico, was that iron was of subsidiary importance in treatment, and that the carbonate, as represented by Bland's pills, seemed to give the best results. Immediately Messrs. M. J. Breitenbach & Co. used this report to exploit their preparation (pepto-mangan)-first in adver- tisements and reading notices and later in a garbled extract of the report printed in pamphlet form and scattered broadcast among physicians. This pamphlet conveyed the idea that pepto-mangan had been endorsed by the government as supe- rior to any other iron preparation, and that it had proved most efficacious in the treatment of anemia; that "this report alone would suffice to establish pepto-mangan at once as the foremost hematinic known." The commission later published a denial, stating that pepto-mangan was used by them only MISCELL A NEO US NO STR UMS 227 for a little while, because it was found to be of even less value than other iron preparations. In another pamphlet sent out by the same company which controls pepto-mangan in this country are statements regarding the treatment of infantile anemia at the Infant's Hospital on Randall's Island, New York City. The Journal sent its own representative to examine the books of the hospital, who found conditions quite different from those represented in the pamphlet. Just as the Porto Rico commission furnished no evidence of such exaggerated value of pepto-mangan, but expressed their opinion that anthel- mintic and not reconstructive treatment is needed in uncinari- asis, . and that iron in othei' forms was of more advantage as far as it went, so in the case of the Infant's Hospital the records and daily charts of the cases show a remarkable differ- ence between the results of treatment and the claims of the pepto-mangan pamphlet. Two things are illustrated by these pamphlets and their refutation. The first is that so-called scientific reports are only of value in proportion to the veracity and reliability of the writer, and the second and equally deplorable fact is that firms composed of men who are per- sonally honorable are willing to obtain business by such unjustifiable methods. If it is said in their defense that they depend on the truthfulness of their writers, it does not relieve them from responsibility. There is too much apparent tend- ency on the part of proprietary houses to accept any report, statement or testimonial that is favorable to their business without question and to suppress apparently unfavorable reports or facts. This tendency has helped to produce the present deplorable condition in the proprietary medicine business.-(Abstracted from The Journal A. M. A., Sept. 23, 1905, and April 6, 1907.) PHENALGIN-A TYPICAL EXAMPLE Last June1 we devoted considerable space to the extravagant therapeutic claims made for "Phenalgin" by its venders. At this time we propose to refer to the misinformation-to use a conservative term-that the Etna Chemical Company has promulgated regarding the composition of their preparation. In June, 1905, the Council on Pharmacy and Chemistry offi- cially published to the medical profession of the United States the information that repeated examinations showed that "Phenalgin" is a simple mixture of acetanilid and sodium 1. See The Journal A. M. A., June 24, 1905, p. 1997. 228 PROPAGANDA FOR REFORM bicarb, or ammonium carb. So far as we know, no direct denial of the truth of this has been made. There has appeared what we presume is meant as an answer; it is couched in this sentence, Phenalgin is just what we have always said it to be. From this expression-which has been repeated in bold, black letters in practically all the advertisements since last June-■ we presume that we are to understand that in the past they have stated what it is. It would have been just as easy and more satisfactory if the Phenalgin people, instead of saying: "Phenalgin is just what we have always said it to be," had said what it is, since the average physician has neither the time nor the inclination to look up their literature. For the benefit of those who desire to know what the vend- ers of Phenalgin "have said it to be," we have gone over their advertising literature of the past, with the following results, which are in the form of quotations from their advertisements: An American Coal-Tar Product-Phenalgin-the only synthetic stimulant, non-toxic, antipyretic, analgesic and hypnotic. Phenalgin is the ONLY ammoniated Synthetic Coal-Tar Product made from Chemically Pure Materials. [What have the Ammonol people to say to this?-Ed.] A synthetic Coal-Tar Product of the Amido-Benzine series, con- taining Nascent Ammonia. These two chemicals ["stimulant ammonia of coal-tar origin" and "chemically pure phenylacetamide"] combine under certain condi- tions so as to obtain a produce which he [Dr. Cyrus Edson] named Phenalgin or Ammoniated Phenylacetamide. Phenalgin is a compound of peculiar character which can not be extemporaneously made into tablets from the powdered drug, without seriously changing and impairing its medicinal qualities. We believe these quotations are sufficient to show what the Etna Chemical Company has "always said it to be." In going over the literature for several years past we find the above stated in the same, or similar, words in nearly all of it. From the above four statements may be deduced: 1. They have stated that Phenalgin is a synthetic1 preparation; 2, they have conveyed the impression that Phenalgin is a chemical com- pound; 3, they have announced repeatedly that it is the "only" preparation of the kind, and 4, they have claimed that Phenal- gin is non-toxic. We believe that these four statements represent in plain English what the above quotations mean. They are all abso- 1. Dunglison's Dictionary: "Synthetic-In chemistry the forma- tion of a more complex body by the union of simpler bodies." Dorland's Dictionary: "Synthesis-The artificial building up of a chemic compound by the union of its elements." "Union" is not mixing. MIS CELL A NEO US NO STR UMS 229 lutely false. Phenalgin is not synthetic; it is not a chem- ical compound; it is not the only ammoniated phenylacetamide, or the only acetanilid mixture containing carbonate of am- monia-and it is most positively toxic. In one place it is stated that Dr. Cyrus Edson Employed his great facilities for chemical research and opportuni- ties for chemical experiment for the purpose of producing a formula for a combination of stimulant ammonia of coal-tar origin (sic) and chemically pure phenylacetamide, also a coal-tar product . . . which he named phenalgin, or ammoniated phenylacetamide. In another place we read that Phenalgin is made Under the immediate personal supervision of the original inventor of ammoniated coal-tar products. By comparing this last quotation-which is from a current- 1905-advertisement-with the preceding one it will be noticed that we are asked to believe that Phenalgin is made "under the immediate supervision of" Dr. Cyrus Edson-and yet Dr. Cyrus Edson died Dec. 2, 1903. This is equal to Lydia Pink- ham's prescribing for the suffering women of America when the dear old soul had been dead for over twenty years. We have before us a full-page advertisement taken from a recent number of a weekly medical journal, which possibly is meant as an answer to the announcement of the Council on Pharmacy and Chemistry that Phenalgin is a simple acetanilid mixture. The advertisement is divided into two parts; the first part is as follows: Facts About Acetanilidum (Ancient History) It has long been recognized that Acetanilidum and most other coal-tar products are apt to exert a depressing influence upon the heart, but there has never been any doubt about its great value as a pain reliever and temperature reducer. Its thera- peutic value has, however, been practically nullified by the danger of cyanosis and other evils caused by its well-known depressant action and the difflculty of obtaining it in a pure state. It being known that certain deleterious substances are often to be found in Commercial Acetanilidum and that much of the injurious effect attributed to this drug is entirely traceable to these impurities.3 The above are also falsehoods. The therapeutic value of acetanilid is not "practically nullified ... by the difficulty of obtaining it in a pure state." Neither is it true that "much of the injurious effect attributed to this drug is en- tirely traceable to these impurities." While deleterious sub- 3. This sentence is not complete, but, of course, this is imma- terial. Little things like an incomplete sentence do not count. 230 PROPAGANDA FOR REFORM stances may be found in commercial acetanilid, they are not found in the substance offered as medicinally pure acetanilid by reputable firms. Pure medicinal acetanilid is a cheap article, costing less than 30 cents a pound, for it is a substance that is easily and cheaply purified. It is a fact that the injuri- ous effects are in the acetanilid itself and not in the impurities it may occasionally contain. The second half of the advertisement in part is as follows: Facts About Phenalgin (Modern Science) More than a decade ago the late Dr. Cyrus Edson, then Health Commissioner for New York City and New York State, recogniz- ing the value of chemically pure Acetanilidum as a therapeutic agent, if it could be deprived of its depressant quality, employed his great facilities for chemical research and opportunities for chemical experiment for the purpose of producing a formula for a combination of Stimulant Ammonia of coal-tar origin and chemically pure Phenylacetamide, also a coal-tar product. These two chemicals combine under certain conditions so as to obtain a produce which he named Phenalgin or Ammoniated Phenyl- acetamide. There is more of the same character. In the first place, we call attention to the fact that "Phenylacetamide" is substituted for "Acetanilidum" when it is to go into Phenalgin. To mys- tify is one of the "tricks of the trade." Few physicians keep up with chemical terms and, therefore, are not supposed to know that Phenylacetamide is one of the chemical names for Acetanilid. The reference here to Dr. Cyrus Edson brings up another fact, and that is that the Etna Chemical Company tries to convey the idea that Dr. Edson was the originator of Phenalgin. We have always understood that Dr. Cyrus Edson had something to do with pushing Ammonol and, if we remember rightly, got into some trouble thereby. We do not know the exact facts, but the following letter shows that he had a leaning toward another "ammoniated phenylacetamid." The letter is dated "New York, Oct. 6, 1894," and is addressed to the "Ammonol Chemical Company." "During the past six or eight months I have used Ammonol extensively in my private practice. I have found it excellent in the treatment of neuralgias and for rheumatism. I have also verified your statement in two cases that were suffering from alcoholism. My experience justifies me in saying that it is the safest and best of the analgesic coal-tar derivatives. "Very truly yours. Ctrus Edson, M.D." It may be of interest to know that the principal member of the firm of the Etna Chemical Company was at one time a MISCELLANEOUS NOSTRUMS 231 member of the Ammonol Company, and it is usually under- stood, we believe, that Phenalgin is practically the, same as Ammonol-in fact, the analyses published regarding the two preparations show this to be a fact. We must make one more quotation: It makes little difference to a physician whether Phenalgin is a mixture or a compound or a synthetic, with a name that would destroy the orthographic balance of the universe, provided it is just what he has always found it to be. Very complimentary to the intelligence and common sense of physicians, is it not? Suppose some fellow should get up a scheme to exploit a mixture of quinin and some cheap, harmless substance, say, starch-equal parts of each. Suppose he gives it a fanciful name, puts it on the market at a high price, say $1.25 an ounce, and announces it as a new synthetic with wonderful therapeutic qualities. Suppose that the schemer then adopts the nostrum vender's methods of fooling physicians into using his product by getting some to give testimonials, others to furnish write-ups, and then subsidizes medical journals through liberal advertising to print both the testimonials and the write-ups. The preparation would, of course, prove to be a good thing if it were used in liberal quantities where quinin would ordinarily be used, and some patients using it would get well even if quinin were not indicated. Then with the psycho- logic effect of the testimonials, the write-ups, and good, strong claims rightly pushed, unthinking physicians would do the rest. And then, after a while, when the schemer had gotten to the point where, each year, he was making a fortune out of his preparation, suppose some "self-appointed chemists" should examine into the preparation and discover that it was nothing but quinin and starch, and so announce to the doctors of the country; what would the doctors say? That it makes little difference "provided it is just what he has always found it to be!" This analogy is not far-fetched, for it is practically what has been done with Phenalgin. One difference is that since quinin costs as much per ounce as acetanilid does per pound, the profits on the acetanilid mixture would be sixteen times greater than that of our imaginary preparation. Another difference is .that acetanilid is really a dangerous drug, unless used with care, both in its immediate and in its remote effects; quinin is far less so. "Little difference" indeed, whether we are being buncoed or not! Evidently! 232 PROPAGANDA FOR REFORM In conclusion, we charge the Etna Chemical Company with intentionally misleading and deceiving the members of the med- ical profession, in that the said company has in its literature and its advertisements conveyed the impression (whether directly stated or not) : First, that its preparation, Phenalgin, is a synthetic compound; second, that Phenalgin requires special skill in its preparation; third, that Phenalgin has therapeutic values which it does not possess; and, fourth, that Phenalgin is non-toxic. We also charge that on account of these and other misrepre- sentations, this company has inveigled physicians into prescrib- ing and using a simple mechanical mixture of common well- known cheap drugs-for which an extravagantly high price is charged-under the supposition that this combination of cheap drugs is a chemical compound of special and peculiar merit as a therapeutic agent, and, therefore, worthy of their confidence. Our object in again giving space to this preparation-and practically all we have said applies to the other acetanilid mixtures that are exploited under fictitious names or as chem- ical compounds (such as ammonol, antikamnia and salacetin or sal-codeia-Bell)-is to impress on physicians, by a typical example, the shamefulness of the deceptions practiced on them by nostrum manufacturers to the great injury of the public and of the medical profession. A PHARMACEUTICAL SECRET WHICH SHOULD NOT BE LOST Dr. Gregory Costigan, New York City, writes under date of January 21, as follows: "I have been carefully reading and enthusiastically ap- proving your articles on the nostrum evil, and have been impressed more than usual on the existence of quack ad- vertising in medical journals as set forth in last paragraph and quotation on page 206, bottom of first column, of your issue of Jan. 20, 1906. "In Merck's Archives, page 11, we are told in an adver- tisement on 'Phenalgin' that it 'is a compound of peculiar character which cannot be extemporaneously made from powdered drug' and 'our process of manufacturing tablets is coincident with the manufacture of Phenalgin and is the result of a long series of careful experiments by which we are able to produce tablets of Phenalgin in a friable condition without losing any of its volatile constituents or undergoing chemical changes from heat or moisture'! In- asmuch as Phenalgin tablets are not covered with a water- proof coating I think this is a remarkable statement to make, and the manufacturing of a drug coincident with the manufacture of a tablet must be a very remarkable MISCELLANEOUS NOSTRUMS 233 performance, especially because it 'retains the full thera- peutic value of the drug unimpaired' while the advertise- ment asserts that no other manufacturer is cognizant of this wonderful method. This ad. is for the perusal of phy- sicians only. The Etna Chemical Company owes it to the medical and pharmaceutical world not to let this secret die with the company's dissolution. It owes it as a duty to the coming generations of science immediately to jot down the full data of this wonderful performance, to put it away in an age-proof safe and not allow it to be lost to humanity as were a great many other arts that were well known to the ancients. Let them keep it secret now and profit by it, but do not let it be lost to posterity."- (From The Journal A. M. A., Jan. 13, 1906, p. 13^, and Jan. 29, 1906, p. 290.) PHENO-BROMATE An analysis of this preparation made at the instance of the New Haven Medical Association, by its chemist, and sent by Dr. Charles J. Foote of New Haven to The Journal is in part as follows: The package was marked "Sample package, Pheno- Bromate. The Pheno-Bromate Company, New York, U. S. A." The box contained a number of tablets and a package of powders in papers marked, "Physicians' 10 grain powders, Pheno-Bromate." The substance in the papers was a white crystalline powder not homogeneous. It was completely soluble in hot water. The hot water solution on cooling yielded a mass of thin crystalline plates. This material was found to melt at 113.5 C. It gave no color with ferric chlorid and a positive isonitril test. The portion insoluble in ether amounted to 49.8 per cent, of the powder and con- sisted of potassium bromid. Quantitative determinations of potassium and bromin in the original solution con- firmed this result. In my opinion, the powder consists of approximately equal quantities of acetanilid and potassium bromid. Qualitative tests of the tablets indicated that they had the same composition except for a small quantity of some incipient not entirely soluble in water. Yours truly, Herbert E. Smith, Chemist New Haven Medical Association. Before the Food and Drugs Act Pheno-Bromate was adver- tised as "a synthetic combination of the phenetidin and bromid groups, and not, as is the case with many analgesics and anti- pyretics, a mixture of various coal-tar derivatives" and as "the safest and best of all sedatives." The dose recommended in most cases is 20 grains - equal to 10 grains each of acetanilid 234 PROPAGANDA FOR REFORM and potassium bromid. Since the Food and Drugs Act has gone into effect its label states that it is "a perfect combination of a phenol and bromin derivative containing 282 grains of acet- phenetidin, U. S. P., per ounce." What a boon it was to men- dacious manufacturers that the patent rights on phenacetin expired before the Food and Drugs Act went into effect.- (Abstracted from The Journal A. M. A., July Uj, 1906, and April 18, 1908.) PHENOLPHTHALEIN Phenolphthalein has long been used as an indicator in chem- ical reactions, but its use as a therapeutic agent1 is com- paratively new. When its laxative properties were first dis- covered it was exploited as a proprietary in Germany, and it was not long before the enterprising manufacturers in this country saw in it a potential gold mine and now nearly every proprietary drug manufacturer in this country has coined a proprietary name for it and is exploiting it, either alone or in combination with one or more other laxatives, and with more or less unwarranted claims. Phenolphthalein itself has certain pretty well defined prop- erties, but when a little of some other drug has been added wonderful therapeutic possibilities are claimed for the com- bination. The drug also has a definite market value and the pure substance in the form of powder, tablets or pills could not be sold at a price greatly in excess of the market value. Thus manufacturers, from business policy, add to it other drugs. There are now on t}ie market numerous more or less secret and "fancy" preparations of phenolphthalein for which a price is charged out of all proportion to the value of the prepara- tion. Among these arc: Phenolphthalein Laxative {El Zernac Co.'). Exurgine {Bischoff <€ Co.). Probilin {Schering <C Glatz). Prunoids {Sultan Drug Co.). Laxine {Columbus Pharmacal Co.). Phenolax Wafers {Upjohn Co.). 1. Those who wish to study the action and use of this drug further will find references to article in The Journal as follows : The Journal, Jan. 5, 1907, pp. 64 and 70 ; March 30, 1907, p. 1133 ; April 20, 1907, p. 1351; Nov. 21, 1908, p. 1782 ; Nov. 28, 1908, p. 1886. The first page mentioned discusses the introduction of phenolphthalein into medicine. MISCELLANEOUS NOSTRUMS 235 Laxaphen (Parke, Davis & Co.). Phenalein (Pane Chemical Co.). Thalosen (Abbott Alkaloidal Co.). Laxothalen Tablets (Pitman-Myers Co.). Veracolate (Marcy Co.). And additional preparations are still coming out! Some of the preparations contain only the phenolphthalein with a coined non-descriptive proprietary name attached, but most of them contain in addition one or more of such drugs as cascara, sulphur, prune, senna, salicylic acid, ipecac and aromatics. The exploitation of phenolphthalein in this way gives oppor- tunity to the manufacturers to make all sorts of strong claims, some of them directly contradictory, for their preparations. For instance, Phenolax, which is said to contain phenolphtha- lein and cane sugar, is claimed to be "a great success for all forms of constipation, intestinal atony and hepatic torpor." Of Laxothalen, which is said to contain phenolphthalein, aro- matics and sugar, it is stated that "its action is confined to the bowel and it has practically no hepatic action." Of Pru- noids, which is said to contain phenolphthalein, cascara, de-emetized ipecac and prunes, we have the old familiar state- ment that "the harmonious blending of the several ingredients will give results that cannot be obtained through their use separately, nor will their use be followed by after-constipa- tion." At the time phenolphthalein was beginning to be exploited in this country The Journal2 suggested that physicians who wished to try the remedy should prescribe it under its own name and not under fancy, coined names. Since phenolphtha- lein occurs in the form of an insoluble and tasteless powder there is no reason' why special pharmaceutical preparations of it should be placed on the market. It can be prescribed in powder form, in pills, capsules or tablets. Thus given, the true therapeutic action of the drug would be apparent and its actual value arrived at. The vice of this unscientific habit of prescribing names instead of drugs is stated in a forcible way in a letter received from Dr. V. E. Simpson, a teacher of materia medica and therapeutics in the medical department of the University of Louisville. He says: "Recently P. D. & Co.'s representative left on my desk a sample labeled 'Laxophen.' The formula given is: phenolph- thalein, gr. viii; salicylic acid, gr. 3/5, in each fluidounce, 2. The Journal, March 30, 1907, p. 1133. 236 PROPAGANDA FOR REFORM. 'incorporated in a palatable chocolate base.' Now, in the first place, this name is one that the public will easily learn and will soon call for; in the second place, it is not a name that carries with it even a suggestion of its contents; and, finally, the physician acquires the habit of mechanically prescribing names instead of drugs, and in the burdening of his memory with the myriad of fantastic labelings he finds it impossible to remember even the drugs any one contains, much less the exact proportions of those drugs. Then suppose that a con- sultation is had; the consultant asks what is being given and the attendant answers that he is giving 'laxophen.' The con- sultant, perhaps, has not been sampled and inquires about it; the attendant must answer, 'Oh, it contains some phenolph- thalein and a salicylate, but I have forgotten the exact pro- portions. I have the literature on my desk. Had he used U. S. P. and N. F. remedies, which the consultant and every other doctor in the land has access to and should have some knowledge of, this embarrassment would not occur.' " All of the above should remind the physician that he should write simple prescriptions, for drugs whose action he knows, adapted to the particular case and not the money-making combinations under fanciful, non-descriptive names exploited by the proprietary manufacturers. In this way he will not only save money for himself and his patients, but he will be giving them exact and effective treatment, he will know exactly what he is giving and learn for himself its effect, and he will be following the only method which entitles him to be called a scientific physician.-(From The Journal A. M. A., April 30, 1910.) PURGEN Phenolphthalein Now Being Exploited in This Country The physicians of the United States are receiving a neat package containing samples of a German proprietary-Pur- gen. The container is an ingenious one and, besides the tab- lets, includes a circular in English, although mailed in Europe, describing the remarkable virtues of this "new synthetic aperi- ent." It has been considered strange that this proprietary, which has been advertised so thoroughly in Europe, Australia, etc., should not have made its appearance in this country. Now it is here, and it is well that physicians should know what Purgen is and not be mystified and misled by the litera- ture that they may receive regarding the preparation. The following appeared in The Journal, Jan. 5, 1907, page 64, and is reprinted now as being especially timely: MISCELLANEOUS NOSTRUMS 237 The report of a case of poisoning by purgen (phenolph- thalein) is the occasion for some pertinent observations by Dr. G. Brasch as to the proper introduction of such rem- edies to the medical profession (Zeitschrift fiir Medizinal- beamte, Abst. in Apotheker-Zeitung, No. 59, 1906). He agrees with Best that all such remedies should first re- ceive a thorough trial in an institution subject to state supervision, before they are advertised to the medical profession, so that their harmlessness in appropriate doses may be ascertained by a method free from liability to error. The manner in which the manufacturers intro- duced Purgen to the profession and the laity is to be condemned, and probably led to the symptoms of poison- ing exhibited in the case of Dr. Best and tends to dis- credit a remedy which is harmless and efficient if used in proper doses. The manufacturer of such a preparation is inclined, for obvious reasons, to put the dose of his prep- aration much too high. The most important point, how- ever, is the objectionable character of the names given to such articles. The organic compound phenolphthalein has been known for a long time and has been widely used as an indicator. Accidentally it was discovered that phe- nolphthalein possessed laxative properties and thereon it was proposed (1901) as a medicine under the name "Purgen." It is sold in tablets containing 0.05, 0.1 and 0.5 grain phenolphthalein mixed with sugar and flavored with vanilla. The author says: "But it is very desirable -and I regard this as the most important part of my communication-that phenolphthalein should be received into the materia medica under its own name. The ad- dition of vanilla and sugar is to the highest degree super- fluous and the arbitrary dosage in three strengths with the ridiculous designations, 'baby,' 'for adults,' 'for pa- tients confined to bed,' are merely calculated to prejudice the physician who is accustomed to individualize in his prescriptions, against a remedy which is in itself an excel- lent one." As explanatory to the last sentence, it should be stated that in Europe Purgen is put up in three dosage forms, "infant Purgen for children," containing % of a grain; "adult Purgen for chronic constipation," containing 1% grains, and "strong Purgen for invalids," containing 7% grains. The form in which it is being sampled in this country is in the medium dose, 1% grains. Physicians should remember that the promoters of Purgen are simply introducing a chemical well known to laboratory workers for the last twenty years, which has been recognized as an aperient for at least seven years, and which can be purchased for 40 cents an ounce, whereas an ounce of phenol- 238 PROPAGANDA FOR REFORM phthalein in the form of Purgen will cost $3.20 wholesale. The enthusiastic praise of the remedy, found in the advertising circulars, should be subjected to critical judgment on account of its source and motives. It is undoubtedly true, however, as we have previously stated, that phenolphthalein is worthy of a trial. In the Brit- ish Medical Journal, Oct. 18, 1902, F. W. Tunnicliffe speaks of the virtues of phenolphthalein, and the conclusions reached by him were that it is a useful aperient, without irritating action on the kidneys, and is especially valuable in jaundice, its depressing action on the circulation being less than sul- phate of magnesia. Phenolphthalein is not in the Pharmacopeia, but has been included in "New and Nonofficial Remedies" by the Council on Pharmacy and Chemistry. From this we quote: Actions and Uses.-Phenolphthalein acts as a purgative, but appears to possess no further physiologic action. A case of poisoning from taking 1 gm. (15 grains) is reported. Dosage.-For adults the average dose is 0.1 to 0.2 gm. (1.5 to 3 grains) given as powder, in cachets, capsules or pills. It may be given with safety in doses of 0.5 gm. (8 grains), and these doses seem to be necessary to secure its effects in bed- ridden patients or in obstinate cases. We have gone into this matter again so that our readers may have some knowledge of this remedy, and we hope that if they conclude to try it they will use the chemical itself and under its own name.-(From The Journal A. M. A., Sept. 11/, 1901, p. 951/.) A Palatable Phenolphthalein Laxative Dr. L. F. Cummings, Hopkinton, Iowa, sends the following formula for a laxative devised by his daughter "to take the place of the similar high-priced preparations": R gm. or c.c. Phenolphthalein gr. cxxviii 1 8. Salicylic acid gr. x or .60 Baker's chocolate SJ 30. Syrup of acacia §j ad 500. Melt the chocolate by aid of heat, mix with the syrup of acacia, then add the salicylic acid and phenolphthalein and mix thoroughly. Dispense with "shake label." Dose: 1 to 3 tea- spoonfuls. Each fluidram contains about 1/15 grain (.004 gm.) salicylic acid and 1 grain (.06 gm.) phenolphthalein.- (From The Journal A. M. A., Jan. 7, 1911.) MISCELLANEOUS NOSTRUMS 239 RESINOL The Philadelphia branch of the American Pharmaceutical Association issued a pamphlet some two years ago in which the following appeared relative to this and similar products: "Within recent years there have been introduced a number of compound ointments that in their supposed range of therapeutic usefulness are. scarcely equalled and certainly not excelled by the magic unguents of the quacks and charlatans of continental Europe, who, several centuries ago, essayed to cure all manner of disease by inunction or the simple applica- tion of compound ointments of secret composition. Photographic reproduction of a Resinol advertisement in a coun- try newspaper. Resinol is supposed to be an "ethical" prepara- tion and, as such, to be advertised only to physicians in medical journals. From the Skidmore (Mo.) New Era. "As typical of this modern class of panaceas we may men- tion Resinol. This preparation is being widely advertised at the present time in the daily papers as a valuable adjunct to Resinol Soap in the treatment of all kinds and varieties of diseases of the skin. The makers of this particular mixture, in the form of an ointment, modestly assert that it will cure all skin diseases, and is also 'A Specific for Pruritus Ani, Itching Piles, and Pruritus Vulva;." (From The Journal A. M. A., Nov. 6, 1909.) SALACETIN Some time ago we wrote to Messrs. Bell & Co., calling their attention to the fact that we had made an examination1 of 1. The Journal A. M. A., June 3, 1905, reproduced on p. 10 of this pamphlet. 240 PROPAGANDA FOR REFORM their product, salacetin, and that as a result of such examina- tion it was found to be a mixture, which did not coincide exactly with their description of it. They replied: "Our description of salacetin is correct and we have nothing more to impart except that any one publishing any different for- mula from that given in our circulars will be held responsible by us." The description they give is as follows: Prepared by the interaction, with heat, of salicylic acid, glacial acetic acid, and purified phenylamine. This sounds very scientific, but when we remember that acetanilid is a result of the action of glacial acetic acid on phenylamine (anilin) their description is cute, to say the least. Of course, there is "interaction with heat" when sali- cylic acid is combining with bicarbonate of sodium to form salicylate of sodium. Further, there is, no doubt, some 'inter- action with heat" when the substances are rubbed together in mixing them and when they are going through the mill to form tablets, not to mention the heated imagination of the promoters of this "synthetic." The following taken from the advertising literature fur- nished by the manufacturers and distributed by them, is quoted to show the claims made for this preparation: Salacetin is free from Toluodine and produces no harmful cyanosis. In the treatment of Acute Bronchitis, Grippe, Influenza, Tonsillitis, Lithemic Headaches, Rheumatism and Neuralgias, it relieves pain, reduces inflammation and abnormal temperature, and eliminates uric acid more quickly and thoroughly than the salicyl- ates, and without causing depression or stomachic or renal irrita- tion. Have personally interviewed thousands of physicians, including every prominent one in the East, and can honestly state that we have never known of anything at once so efficient and so unobjection- able in the removal of rheumatic and neuralgic pain and other symptoms of the uric-acid accumulation. ... La Grippe and Acute Bronchitis it relieves pain and coughing, reduces inflammation and temperature, makes the patient comfortable, and checks the progress of the disease. In Tonsillitis its action is specific. . . . In Acid Cystitis, it neutralizes acidity, reduces inflammation and removes irritation. ... In Dysmenorrhea it relieves pain and congestion with no hallucinations, constipation or danger of a drug habit. In Dysmenorrhea and Ovarian Neuralgias try Sal-Codeia-Bell. It will relieve the pain as well as morphia. It will not check any secretions, induce any habit, cause any depression or inconvenience of any kind. Of course, it is well understood that acetanilid is a valu- able remedy in many instances, if used with caution and when indicated. It certainly has some therapeutic value. There is no doubt that it relieves pain of various kinds. It is to MISCELLANEO US NO STR UMS 241 be presumed that combining salicylate of sodium with it will have certain beneficial effects in certain rheumatic conditions, on the supposition that salicylate of sodium and acetanilid are both used with more or less success in certain of these conditions. Also, the combining of bicarbonate of sodium, .carbonate of ammonia, caffein, citric acid, one or several of these, may result in a fairly good combination, but these combinations can be found in the list of preparations of all our large manufacturing pharmaceutical houses, which supply them at one-tenth of the cost of these secret remedies. The physician in using these preparations put out by reputable recognized manufacturing pharmaceutical houses, not only is prescribing preparations that are non-secret, but is using remedies that cost one-tenth as much as the secret prepara- tions, which are exploited under fanciful names and pushed by ridiculous claims.-(From The Journal A. M. A., July 1, 1905, p. 55.) SAL-CODEIA-BELL According to the advertisements "Salacetin": Is a combination with heat of salicylic and glacial acetic acids with phenylamiiie, the irritating, depressing and blood-corpuscle destroying elements removed. According to the Committee on Chemistry of the Council on Pharmacy and Chemistry of the American Medical Associa- tion, whose report was published in The Journal of the American Medical Association June 3, 1905, p. 1791, "Salace- tin" is a mixture of acetanilid, salicylate of sodium and bicar- bonate of sodium. Sal-Codeia (Salacetin-Codein), therefore would be the same as the above with codein added. Of course, acetanilid and codein will relieve pain (it could not do other- wise) and consequently make a very good combination in certain conditions, if not used too often and if used with care. While the continued use of codein is not likely to produce a drug habit, it, as well as acetanilid, does so sometimes, and it must be remembered that codein is a motor paralysant, and is not the best combination to be used with acetanilid. For those who wish to give a combination of acetanilid, salicylate of sodium and codein, the following prescription is suggested: R. Acetanilid 3i 4| Sodii bicarbonatis 3ss 2| Sodii salicylatis . .3ss 2| Codein sulph gr. vi 14 M. et div. chart No. xxiv. 242 PROPAGANDA FOR REFORM This will make five-grain powders which may be put in papers, capsules, cachets or tablets. Each will contain 2% grains (0.15) of acetanilid and 154 grains (0.075) each of sodium salicylate and sodium bicarbonate, with 54 grain (0.015) of, codein. The doses of acetanilid and of codein approximate the aver- age adult doses, but the sodium salicylate, to have any appre- ciable effect, must be increased, for 154 grains of salicylate of sodium in a dose is insignificantly small. Sodium salicylate with acetanilid makes a fairly good combination in certain rheumatic troubles, but it is not indicated by any means as a cure-all, as one would judge from the literature sent out by the Sal-Codeia-Bell people.-(From The Journal A. M. A., Nov. 4, 1905.) SAL HEPATICA This wonderful mixture, according to the advertisements, is "a combination of the tonic, alterative and laxative salts similar to the celebrated 'bitter waters' of Europe, as deter- mined by actual chemical analysis of these waters, and forti- fied by the addition of lithia and sodium phosphate"-a descrip- tion, by the way, that is used verbatim et literatim by the A. D. S. in describing its "Hepatic Salts." As usual, in inflicting this remedy on the public, the manu-\ facturer makes use of cast-off medical theories and unwar- ranted claims. The marked absurdity of some of the state- ments indicates that they are intended for the lay public. Surely no nostrum-maker would suppose that he could delude even the most credulous portion of the medical profession into believing the statements made in the advertisements concerning sal hepatica, namely, that the same remedy is a uric-acid eliminant, hepatic stimulant, a specific for gout, rheumatism, cirrhosis of the liver, Bright's disease, gravel, tuberculosis, struma, marasmus, dyspepsia, infantile fluxes, etc. The following analysis of "Sal Hepatica" was published in the Druggists Circular, February, 1909, p. 78: Sodium chlorid 13.05 parts Sodium sulphate 26.27 parts Sodium phosphate . .. 29.80 parts Sodium bicarbonate 18.00 parts Lithium phosphate ., 0.04 part Citric aud tartaric acids, to make 100.00 parts Our old friend lithium is added, undoubtedly, to influence the few physicians who still accept the discarded theory MISCELLANEO US NO STR UMS 243 regarding the solvent effect of lithium salts on uric acid. Such physicians must be easily influenced if they can believe that 4/10,000 parts of lithium would have any therapeutic effect! Thus once more the medical profession is asked to indorse a nostrum consisting of a mixture of simple saline laxatives such as any physician can prescribe and any drug- gist prepare, and to sanction the blatant advertising of the mixture as a specific in such grave maladies as cirrhosis of the liver and Bright's disease. This advertising has already made the drug known to the laity, who see in the shrewdly chosen name an indication of the use of the nostrum in liver disease and that undefined but favorite malady of the public, "biliousness." The abuse of saline cathartics by the public is an evil deserving of serious attention. Rightly or wrongly, the laity fear constipation, and naturally take what they are taught to believe is the cheapest and simplest course for its relief, self-drugging by means of saline cathartics or the extensively advertised purgative mineral waters. This habit is responsible for much of the distressing spastic constipation that exists, and its accompanying neurasthenia. The advertisement and sale to the laity of such a nostrum as "Sal Hepatica" can only increase these evil results and the physician who aids and abets the evil by using the preparation should reflect whether he is thereby not only encouraging a fraud on the public, but also, what is even worse, helping to impair the public health.-(From The Journal A. M. A., March 26, 1910.) SANATOGEN-ITS FOOD VALUE To the Editor:-Will you kindly tell me whether or not Sanatogen has any food value? Abch Dixon, Jb., M.D., El Paso, Texas. Answer.-Sanatogen is said to contain 95 per cent.of casein so that 30 gm. (1 ounce) of this preparation would contain approximately 28.5 gm. of protein, which would yield 117 calories. This is the equivalent in round numbers of one- third of a pint of milk or one and one-half eggs. The same amount of energy would be given by an equal weight of starch or by one and one-fifth as much of flour or other cereals. To present the matter even more graphically, it may be said that $1 worth (4 ounces) of Sanatogen yields approximately no more energy than G cents' worth of good milk or 1 cents' worth of ordinary wheat flour. Sanatogen, therefore, like most preparations of this class, while a food, is a ruinously PROPAGANDA FOR REFORM 244 expensive one. The absurdly exaggerated claims regarding it were discussed in The Journal, Feb. 19, 1910, as follows: "According to the manufacturers, this patent medicine-or food-is composed of 95 per cent, casein and 5 per cent, sodium glycerophosphate. The prepara- tion is advertised very extensively both to physicians and to the laity, on both sides of the Atlantic. In Great Britain it is a 'tonic food,' in this country a. 'food tonic;' whether this is a distinc- tion with or without a difference, it is hard to say. The public is told that Sanatogen is a 'muscle builder and a nerve and brain food;' the medical pro- fession, that 'it should not be regarded as a food preparation in the ordinary sense of the term and it is not offered as such to the medical profession. . .' Many of the claims made for this com- bination of milk-curd and glycerophos- phates are exaggerated and absurd. The following are taken from advertisements, appearing both in this country and abroad: 'The Re-Creator of Lost Health.' 'Sanatogen is ... a rebuilding food.' '. . . revitalizes the overworked nerv- ous system.' 'Specific nerve tonic action.' 'Most reliable and scientific of all nutri- ents.' ". . . in certain diseases it exerts a specific action which renders it a valuable adjunct to other curative measures.' "In one of the form letters sent to physicians, the makers of Sanatogen opine that 'you have likely noticed' an article that appeared 'in the May issue' of a certain medical journal. The ingenuousness of this intimation becomes apparent when it is known that a few days previous to receiving the letters, the physicians had been the recipients of pamphlet reprints of said article-'With Author's Compliments.' "That milk curd has a food value no one will deny; that the glycerophosphates of soda have a place in medicine may be admitted; but that a combination of these two products should become at once the summum bonum of medicinal foods is a proposition that will not appeal to. the thinking physician." (From The Journal A. M. A., May 6, 1911.) SANATOGEN C 0 W'S MILK :» H E A T. . F L Q U R.- Graphic illustra- tion of the amount of energy produced by one dollar's worth of Sanatogen, of cow's milk and of wheat flour, respec- tively. It is evident that it would require one hundred dollars' worth of Sanatogen to give the same energy as one dol- lar's worth of ordi- nary wheat flour I MISCELLANEOUS NOSTRUMS 245 SYRUP OF COCILLANA COMPOUND A physician in a small town in Nebraska writes: "In look- ing over a prescription file not long ago I found a prescription which I copied and am sending to you. It is a good example of shot-gun prescribing. I do not give the name of the pre- scriber, and you will please not mention from whence this comes. The doctor who wrote this has had about ten years' experience." Here is the prescription given exactly as transmitted by our correspondent: Sp. sticta Gtt xv Sp. ipecac Gtt x Sp. bryonia Gtt x Sp. macrotys ., 5i Bromoform Bronchial Anodyne §ii Syrup Cocillana Comp. q. s. ad 5vi Teaspoonful every two or three hours. It is evident that the prescriber is an eclectic. As a matter of fact, in a second letter from the physician who forwarded the prescription, we are informed that the prescriber is a graduate of an eclectic institution not a thousand miles from where he practices. The "Sp" in the prescription does not mean "Spiritus," but specific tincture. The prescriber is an advocate of specific remedies, one of which should fit the condition, but he is broad-minded enough to call help from the outside, and so adds fifteen other remedies to the spe- cific selected, including alcohol. The inability of one mind to remember all the ingredients of so complex a mixture will explain the fact that ipecac is duplicated, dccurring both as a specific tincture and as an ingredient of Bromoform Bron- chial Anodyne. The latter, the manufacturers tell us, con- tains in one fluidounce: Alcohol 5 per cent. Bromoform 8 drops Ipecac l % gr. Ammonium bromid 24 grs. Benzoin 1 gr. Syrup Cocillana Comp., one of the "elegant specialties" of Parke, Davis & Co., of which they certainly ought to be very proud, contains, we are told, in one fluidounce: Alcohol 5 per cent. Heroin hydrochlorid 8/24 gr. Tinct. of euphorbia pilulifera 120 min. Syrup of wild lettuce 120 min. Tinct. of cocillana 40 min. Syrup of squill comp 24 min. Cascarin, P. D. & Co 8 grs. Menthol 8/100 gr. 246 PROPAGANDA FOR REFORM This "elegant specialty" of P'arke, Davis & Co. is not only a shot-gun prescription, but has as one of its ingredients a mixture itself containing three ingredients, namely: Syrup Squill Comp. (Coxe's Hive Syrup), making ten in all-a beau- tiful example of scientific pharmacy. We wonder if our eclectic brother really appreciated that his prescription, written out, would be as follows: Sp. sticta Gtt xv Sp. ipecac ■ Gtt x Sp. bryonia Gtt x Sp. macrotys 3i Alcohol 5 per cent. Bromoform 8 drops Ipecac % gr. Ammonium bromid 24 grs. Benzoin 1 gr. Alcohol 5 per cent. Heroin hydrochlorid 8/24 gr. Tinct. of euphorbia pilulifera 120 min. Syrup of wild lettuce 120 min. Tinct. of cocillana 40 min. Fluidextract of squill 60 min. Fluidextract of senega 60 min. Antimony and potassium tartrate 1 gr. Cascarin, P. D. & Co 8 grs. Menthol 8/100 gr. To use a slang expression, this is certainly going some!- (From The Journal A. M. A., March 18, 1911.) TARTARLITHINE Tartarlithine was examined by two chemists whose reports indicate that it is an effervescing preparation composed approximately of 20 per cent, of carbonate of lithium and about 80 per cent, of tartaric acid. Thus it is simply another of the hundreds of lithia preparations on the market offered for the cure of rheumatism. This in spite of the fact that scientific investigation and clinical experience have demonstra- ted that lithia is of very little use in the treatment of that disease. While the advertisement carries the idea that tartar- lithine is a product of the Tartarlithine Company, and that McKesson and Robbins are simply selling agents, we are informed that the business is owned by McKesson and Robbins, who under this style manufacture a remedy for rheumatism.-(Abstracted from The Journal A. M. A., April 23, 1907, p. 128',.) MISCELLANEOUS NOSTRUMS 247 TOXICITY OF THE ARYLARSONATES Soamin * A correspondent in tire British Medical Journal (March 5, 1910, p. 599) calls attention to the dangers of the arylarson- ates, "Orsudan" and "Soamin." The latter is probably better known to American readers under the earlier name "Atoxyl," Atoxyl and Soamin differing only in the number of molecules of water of crystallization. The correspondent states that the success which attended the use of these preparations in a series of twelve cases of syphilis induced him to continue it until an untoward occurrence compelled him to abandon it and to regret that he had ever advocated it. The untoward occurrence was blindness from double optic atrophy after ten injections of Orsudan. He says further: "A second case has recently come under my notice in which a syphilitic patient also became blind after a course of about fifteen injections of 5 grains of Soamin (Burroughs, Wellcome & Co.). A third case is that of an elderly patient, with marked arterial degeneration, who was put on a course of injection of Soamin (Burroughs, Wellcome & Co.) for sciatica, but who after the introduction of about 60 grains also met with a similar fate. I am also cognizant of a fourth case, in which a patient suffering from lymphadenoma was treated with Soamin (Burroughs, Wellcome & Co.), and became totally blind. "It is inexpedient to enter more fully into the history of these cases, and I should not have written this communication had not I recently received from Messrs. Burroughs, Wellcome & Co. a pamphlet commending their preparations, Soamin and Orsudan, and reproducing among others the cases I originally described. In this pamphlet a casual mention is made of the fact that signs of intolerance had been met with after the use of Soamin, such as 'visual disturbances, nausea, vomiting, gas- tric pains, dermatitis, nervousness, and insomnia,' and that 'the appearance of any of the above symptoms should be a signal for withholding the drug.' This is the only warning- note in this pamphlet, though the manufacturers, through one of their representatives, had been informed by me of one ease of total and irremediable blindness which had occurred after the use of Orsudan, and knew that I had abandoned the treat- ment on that account. "Further, in the British Medical Journal, Jan. 22, 1910, Drs. Lundie and Blaikie describe a case of total blindness fol- lowing on a course of Soamin and the possibility of causing optic atrophy by the use of that substance is alluded to. In the Lancet, ii, 1909, p. 1196-, Dr. Bagshawe writes: 248 PROPAGANDA FOR REFORM " 'The arsanilates, and especially Atoxyl, are not without their dangers ; there are many recorded cases of blindness following the use of Atoxyl ... It seems that loss of vision is less frequent, if it occurs at all, after the use of Soamin, which has of course a chemical formula identical with Atoxyl.' "There was, therefore, in the medical journals some indica- tion that these drugs were not quite so innocent as they had been depicted. In the strict sense of the word, I suppose that total and incurable blindness may be termed a 'visual distur- bance,' and my only object in writing is to point out to your readers the possible gravity of that 'visual disturbance' and to put them on their guard against such a disastrous occur- rence." The history of the commercial exploitation of "Atoxyl" and "Soamin" cannot be viewed by the physician with any satis- faction; yet it is unfortunately being repeated almost daily. A writer1 in The Journal, Aug. 14, 1909, p. 497, selected this history as an example of the unsatisfactory conditions pre- vailing in the introduction of new drugs. To quote from this article: "That physicians have been content and have received but half-truths concerning important matters is too well known to need much discussion. One illustration of recent date may, however, be given. Reference has already been made to a class of organic arsenic compounds which are attracting much attention. As they seem destined to attract still more interest in the future, and as many new compounds of the same class are being investigated, it was especially desirable that the first information given concerning them should be correct and complete. Yet the very first one, under the name Atoxyl, was brought to the attention of the physician with an incorrect statement even as to its composition. Professor Puckner, sec- retary of the Council on Pharmacy and Chemistry, seems to have been the first to discover the discrepancies between the manufacturer's statement and the truth. His results were soon confirmed by Ehrlich." "New names for old drugs are often introduced in a manner to lead the physician to suppose that a new drug is being introduced. For example, I recently received a circular on 'Soamin' from a leading English firm. In this it is stated that 'the arylarsonate, "Soamin," was first introduced at the end of 1907,' and there is nothing in the circular to indicate that the same substance had been introduced by another firm several years previously under the name 'Atoxyl,' or that the compound itself had been made in 1863 by Bechamp. A little further on in this circular I read: 'The toxic symptoms 1. Hunt, Reid: "What the Individual Physician Can Do to Improve the Materia Medica." MISCELLANEOUS NOSTRUMS 249 noticed by continental physicians when using other arylarson- ates have not been observed with Soamin.' As a matter of fact, most of the toxic symptoms noticed by continental writers were due to the same substance but under a different name." There are certain points of resemblance between this his- tory and that of the blindness from wood alcohol which shocked the public a few years ago. Certain dealers in wood alcohol represented that their product was harmless on account of its purity and a number of manufacturers were per- suaded to use it, with most disastrous consequences not only to many innocent parties who lost their lives or sight but to themselves. The medical profession is now in somewhat the position of these manufacturers: dealers in all sorts of new drugs are representing that their purified products are harm- less and the consequences are too often similar to those described above. The physician is learning (reluctantly and regretfully, for he likes to feel that the manufacturers who express so much solicitude for his success in practice are dealing with him perfectly frankly) that the only safe way is to be profoundly skeptical of the statements of those who have something to sell; unfortunately this skepticism is necessary in regard to the products of the "great manufacturing houses" and some of the German professors as well as in regard to many of the humbler proprietaries. It is probably a utopian dream but we still hope that a time will come when the contributors to the materia medica will come from well endowed medical schools and hospitals.-(From The Journal A. M. A., April 16, 1910.) Arsacetin Dr. 0. H. Benker, St. Louis, writes: "The article on Soamin in The Journal, April 16, 1910, p. 1323, brings to my' atten- tion sodium p-acetylaminophenyl arsonate (Arsacetin) manu- factured by Farbwerke vorm. Meister Lucius & Bruening,, Hoechst, a.M., Germany. The literature from the manufac- turer cites such authors as Neisser using it for subcutaneous applications in 9 grain doses, up to 20 injections. Kindly state whether this drug has produced any blindness or whether it is free from such dangers." As the use of Atoxyl showed that it was liable to produce blindness, an attempt was made to secure a less poisonous product by introducing other radicles in place of hydrogen in the amino group. Arsacetin was one of these which appeared likely to be less liable to produce unfavorable results than Atoxyl. It differs from Atoxyl by the introduction of the 250 PROPAGANDA FOR REFORM acetyl radicle into the amino group of atoxyl, in other words, it is acetyl-atoxyl. Experiments on animals showed it to be less poisonous than Atoxyl, thus the experiments of Blumen- thal, (Med. Klin., Nov. 1, 1908, p. 1687) show that rabbits which would succumb to a dose of 0.4 to 0.5 gm. of Atoxyl, bore doses of 0.6 to 0.8 gm. of acetyl-atoxyl (Arsacetin). It is to be noted that these doses show relatively less toxicity for Arsacetin but the difference does not seem to be very great. Arsacetin has now been used in a considerable number of cases and it appears that it has given rise to blindness in such a number of cases that it does not seem likely that it will fulfil the expectations of its originator by proving much less toxic than Atoxyl. Rente (Munchen, med. Wchnschr., April 6, 1909, p. 718) reports a case of atrophy of the optic nerve after the use of 3.6 gm. of Arsacetin. J. Iversen (Miinchen.* med. Wchnschr., Aug. 31, 1909, p. 1785) used Arsacetin in 148 cases of relapsing fever, in one of which permanent blindness due to toxic retro-bulbar neuritis occurred. The patient received 0.7 gm. and after seven days 0.5 gm. of Arsacetin. Paderstein (Berl. klin. Wchnschr., May 31, 1909, p. 1023) reports the observation of H. Lehmann, who administered Atoxyl to a patient to the extent of 3.4 gm. without benefit. After some months six injections of Arsace- tin, amounting in all to 1.5 gm. were given, and soon after this complete blindness suddenly occurred. F. Hammes (Deutsch, med. Wchnschr., Feb. 10, 1910, p. 267) reports a case in which he gave in eight doses 0.8 gm. of Arsacetin, which was followed by complete blindness and finally by death; the death, however, was probably not due entirely to the Arsacetin. He refers also to the report of Eckard (Archiv f. Shiffsund Tropenhygiene, xiii, 16), who saw 3 cases of blindness among 134 cases of sleeping sickness treated with Arsacetin. There are therefore in the literature reports of 7 cases in which blindness was undoubtedly due to this remedy. It is interesting to note that the experiments of Blumenthal with various derivatives of Atoxyl in which substitutions were made in the amino group showed no constant reduction of toxicity. Blumenthal suggests that a change in the arsenic group may cause an enormous increase in the toxicity. A para-aminophenyl arsenous oxid obtained by the reduction of atoxyl produced death in a rabbit weighing 2,800 gm. in the small dose of 0.02 gm. It is quite possible that the occasional instances of severe poisoning by Atoxyl and Arsacetin are due to reduction in the system which the physician can neither foresee nor control. MISCELL A NEO US NO STR UMS 251 G. Meszczersky (Vrach. Gaz., 1909, No. 27) reports unfavor- able results in the treatment of syphilis by Arsacetin and remarks on the toxic action of the kidneys. In view of the foregoing it is evident that the greatest caution should be exercised in using a remedy capable of producing such serious side results. In this connection the conclusions of Hammes are worth quoting: "Finally I am inclined to believe that in Arsacetin we have made a step forward in a path that prom- ises marked success, but for general use this method is not yet applicable. As far as the application of this new prepar- ation of arsenic in internal medicine, it is for the present not suited to displace the forms of arsenic previously used and to influence our previous treatment. The apparent benefits occa- sionally obtained in a small series of observations are abund- antly counterbalanced by the damage which under some circumstances will quite overcome all of the satisfaction received from a success obtained in a probably unexpected way. Especially for physicians in practice to whom other consider- ations are of importance in addition to the general ethical viewpoint of our science, an attitude of marked conservatism toward the remedies of this group is decidedly to be recom- mended." In the foregoing no criticism is intended on the method of introduction of Arsacetin. The remedy has been put before the profession with very conservative statements and with an evident desire to supply a less dangerous preparation than atoxyl.--(From The Journal A. M. A., May 7, 1910.) TUBERCULOIDS The following card is sent out to the public by the Colum- bus Pharmacal Company, Columbus, Ohio, and a copy was sent to The Journal office by Dr. N. S. Davis: PHTHISIS PULMONALIS CURABLE By the Germicidal, Antiseptic (non-irritating). Alterative, Reconstructive and Restorative Properties of Tuberculoids Treatment for Tuberculosis. The medicinal factor being Tuberculoids Tablets, a chemical production proven effica- cious by bacteriological tests, substantiated by practical use by physicians under all kinds of climatic and systemic con- ditions. Full size package ($1.50 size, 200 tablets) fur- nished free to accredited practicing physicians on return of the attached card. Ample information furnished by personal letter for intelligent administration. Originated and manufactured only by Columbus Pharmacal Company, Columbus, Ohio. Serial No. 3219, Guaranteed under the Food and Drugs Act, June 30, 1906. 252 PROPAGANDA FOR REFORM Some of the literature and a sample of the preparation were submitted to the chemical laboratory of the Association and the chemists were asked for an opinion and a report. The chemists declared that the statements made were typical of those made for the average "patent medicine." While pre- tending to give exact information regarding the composition of the remedy, the literature contains only mystifying phrases. The formulas given are criticised, and it is stated that they are evidently intended to mislead. Apparently, the tablets contain bismuth, possibly a nitrate of bismuth, a compound of guaiacol and a salt of cinnamic acid. There is no class of patients whom the nostrum maker can influence more easily than consumptives; they are always hopeful and ever ready to praise any remedy they happen to use. This is undoubtedly the reason why the "consumption cure" promoters succeed in getting so many testimonials. Attention is directed to the fact that the statement "guaranteed under the Food and Drugs Act" does not carry with it any guarantee of the purity of the preparation or of its efficacy in the class of cases for the cure of which it is advertised.-(Abstracted from The Journal A. M. A., Feb. 29, 1908, p. J01h) VAPO-CRESOLENE Vapo-Cresolene has been examined in the American Medical Association's laboratory and the chemists' report follows: According to the statements on the trade package, Vapo- Cresolene "is a product of coal-tar possessing far greater power than carbolic acid in destroying germs of disease." It is recommended as a remedy for a number of diseases, including croup, catarrh and diphtheria. According to the manufacturers, it should be used only in "the Cresolene vapor- izer," which makes it "unequaled for the disinfection of sick rooms" and the "safest and simplest method of destroying infection and purifying the air." From the examination we conclude that Vapo-Cresolene is essentially cresol and corre- sponds in every respect to cresol U. S. P. (Physician's Man- ual, page 36). This report indicates that Vapo-Cresolene is a member of that class of proprietaries in which an ordinary product is endowed, by the manufacturer, with extraordinary virtues. The type is so common and has been referred to so frequently that but for the dangers attendant on the inhalation of any of the phenols, this particular product need not have been mentioned.-(From The Journal A. M. A., April J/, 1908, p. 1135.) MISCELLANEOUS NOSTRUMS 253 VASOGEN AND IODOVASOGEN Another Case in Which Independent Analyses and Manu- facturers' Labels Disagree Vasogen, a product of Pearson & Company, Hamburg, Ger- many, has been put on the market under the various desig- nations, "oxygenated vaseline," "water-soluble hydrocarbon" and "oxygenated hydrocarbon." The manufacturers, and also their American agents, Lehn & Fink, claim that by a special process the apparent impossibility of saponifying petrolatum has been overcome with Vasogen as the result. Disinterested chemists who have analyzed Vasogen find that the product consists essentially of an ammonium soap and petrolatum- practically an ammonia liniment mixed with petrolatum. Just as petrolatum under its various trade names was at one time recommended as a universal ointment base, so vaso- gen is recommended promiscuously as a vehicle for remedies applied externally and even for internal medication-needless to say in many cases in which it is directly contra-indicated. lodovasogen, recommended for external application as a substitute for tincture of iodin, was examined by Zernik in 1905, who found that the iodin existed not as a free iodin, but chiefly as ammonium iodid. The therapeutic char- acter of the preparation is thus entirely different from that to be inferred from the labels and elsewhere, since the counter- irritant effects of free iodin are of course absent in am- monium iodid. Pearson & Co. now claim that when Zernik's findings were published they immediately modified their state- ments on the label in accordance with the truth. This is de- nied by Dr. Lungwitz, the editor of the Therapeutische Rund- schau (Apotheker Zeitung, 1908, p. 900), who vigorously crit- icizes the misrepresentation made by Pearson & Co. in regard to lodovasogen. He calls attention to the fact that, while Zernick's results were published over three years ago, the labels which are in use to-day still bear the statement that lodovasogen consists of Vasogen 90 parts and resublimed iodin 10 parts, and Vasogen 94 parts and resublimed iodin 6 parts, respectively. As lodovasogen and Vasogen in various combinations, are being advertised to the physicians in the United States, the above information from our German exchanges is worthy of consideration.-(From The Journal A. M. A., Feb. 13, 1909.) PART IV MISCELLANEOUS MATTER CALCIUM CHLOROPHOSPHATE A correspondent asks: "What is the nature and therapeutic action of chlorophosphate of calcium which is given as an ingredient of Pautauberge's solution on the enclosed postal? W. H. S." The postal sent by our correspondent is an advertisement of Pautauberge's solution purporting to be "Notes on Modern Pharmaceutical Remedies from American Medicine." "Bib- liography omitted to save space." From this postal we learn that each tablespoonful contains "creosote 2 minims, chloro- phosphate of lime 8 grains." Under "indications" we are told that "Pautauberge's solution of creosote with the chlorophos- phate of lime is extensively used and recommended by French physicians in the treatment of pulmonary tuberculosis, chronic bronchitis, emphysemia (?), asthma, tuberculous infections in general, chronic intestinal diseases and wherever creosote would be indicated." There is no such substance as "chlorophosphate of lime." There is chlorid of calcium and there are also several phos- phates ' of calcium. Possibly the enterprising manufacturer has given this name to a solution of phosphate of lime in hydrochloric acid in the effort to mystify and impress the physician who may be led to believe that he is using a new and important remedy. This is another example of the attempt to make scientific theories serve the needs of manufacturers of proprietary rem- edies. ' The manufacturer infers from two views of tubercu- losis the need of remedies which his solution is designed to supply. A. Robin and Ferrier claim that a . deficiency in calcium salts favors tuberculous infection, hence the need of "chlorophosphate of lime" which Pautauberge can alone sup- ply. Even if there were a basis of truth in the theory, there is certainly no reason to suppose that the quality of calcium salts supplied by American pharmacists is in any way inferior to similar salts made in France. Again, we are informed that the most probable port of entry for the tubercle bacillus is the intestinal tract and the creosote MISCELLANY 255 in the solution (2 minims to the tablespoonful) is supposed to ward off the danger of intestinal infection. Considering that several pounds of matter, solid and liquid, pass through the intestinal canal daily, is there not great danger that the 6 minims of creosote will fail to find some of the tubercle bacilli in the large mass of food and drink and swallowed sputum through which they are distributed?-(From The Journal A. M. A., May 7, 1910.) Calcium Chlorhydrophosphate C. R. Noyes, pharmacist, St. Paul, Minn., calls attention to the formula on page 152 of the National Formulary, which he thinks of interest, in view of the article given above. The formula referred to is for "syrupus calcii chlorhydro- phosphatis," or syrup of calcium chlorhydrophosphate. In the preparation of this syrup calcium phosphate is dissolved by the addition of hydrochloric acid. It therefore does not con- tain the hypothetical or impossible compound indicated by its title, but instead appears to owe its therapeutic value to cal- cium acid phosphate and calcium chlorid. Thus The Journal's criticism of Pautauberge's solution, to the effect that it is claimed to contain a chemical substance unknown to chemists, may with equal fairness be applied to the National Formu- lary preparation referred to. The assertion has been made that a number of the preparations in the National Formulary have been devised in imitation of, or, rather as substitutes for, certain proprietary mixtures which had become somewhat pop- ular. This assertion derives a certain degree of support by a comparison of the two preparations in question. In naming the preparation, it is probable that the makers of the formu- lary were guided by the composition claimed for Pautauberge's solution, although they should have known there is no such substance as calcium chlorhydrophosphate.-(Modified from The Journal A. M. A., July 9, 1910.) THE INTERNATIONAL ENCYCLOPEDIA OF ETHICAL NON-OFFICIAL PHARMACEUTICALS The commercial possibilities of a book like New and Non- official Remedies published by the Council on Pharmacy and Chemistry have evidently never been realized. As physicians know, products cannot get into N. N. R. unless they possess value and are advertised honestly; when they conform to the rules of the Council, however, it costs nothing for them to 256 PROPAGANDA FOR REFORM appear in that useful publication. Therein apparently N. N. R. differs from another compilation that may be expected to appear some time in the future-known by the sonorous and high-sounding title, "International Encyclopedia of Ethical Non-official Pharmaceuticals." This stupendous work is to be published by a New York concern known as the Medical Re- search Corporation and has for its editor Virgil Coblentz, A.M., Phar.M., Ph.D., and for its associate editors George C. Diek- man, Ph.G., M.D., and Albert A. Ripperger, M.D. The pres- ident of the "corporation" is Henry E. Fanshaw, who, we understand, was formerly with the exploiters of "Fluid Hygenique"-the Hef Chemical Company, of New York City. The method of "compiling" the list of "ethical non-official pharmaceuticals" which is to make up the "international en- cyclopedia" seems to be about as follows: A letter is sent to a pharmaceutical house asking the concern to send descriptive matter regarding such of its products as are of special interest to physicians. Should this be sent, its receipt is acknowledged and an interview is requested. The interview makes clear the vast possibilities that still lie in the proprietary medicine busi- ness-for a virile advertising concern. To make it more plain: The following contract is submitted to the pharmaceutical manufacturer who may have deluded himself into believing that he was doing a favor in telling the "International Ency- clopedia" people all about his "ethical non-official pharmaceu- ticals:" This contract, it will be noticed, pertains to "proprietaries;" there is a different one for "synthetics." That is to say, the figures on the latter are different; the words are practically the same. Whereas the manufacturer must pay $500 for a half- page notice of his "proprietary," he need only pay $200 for the same amount of space devoted to his "synthetics." What subtle scientific distinction is drawn between "synthetics" and "proprietaries" is not clear; of course, the other distinc- tion is quite evident-$300. It is probable that the makers of proprietaries that are de- barred from "New and Non-official Remedies" will welcome the opportunity to "put one over" on the Council on Pharmacy and Chemistry by having their preparations appear in all the glory of a half-page reading notice in the "International Encyclo- pedia of Ethical Non-Official Pharmaceuticals." As the "encyclopedia" is to be "international" in scope, we may expect to find our German friends, who are long on "synthetics," well represented in the $200 section of this MISCELLANY 257 PROPRIETARIES The Parties in this agreement incur no obligation other than those within mentioned. $ New York, 191. . Medical Research Corporation, Publishers, 2 Rector Street, New York City. In consideration of the services rendered by you to members of the medical and pharmaceutical professions, in the publica- tion of the International Encyclopedia of Ethical and Non- Offlcial Pharmaceuticals, wherein proper representation of our product is made to the extent of one-half page, and in consideration of your printing and delivering, at your expense, copies of the said "Encyclopedia" to the individual members of the medical profession in the United States and Canada (approximating 135,000), we hereby agree and bind our- selves to contribute the sum of Five Hundred ($500) Dollars, which shall be paid to you in the following instalments : One Hundred and Fifty ($150) Dollars at the signing hereof; One Hundred ($100) Dollars upon our being provided with a copy of the matter devoted to our product and the remaining Two Hundred and Fifty ($250) Dollars at the time that the said International Encyclopedia of Ethical Non-Ofiicial Pharmaceuticals shall have been distributed to the practicing members of the medical profession as hereinbefore mentioned, through the United States mail or otherwise. Name Signed by Address Accepted subject to approval of Board of Editors, Medical Research Corporation, By extensive compilation. The book will doubtless fill a long felt want-of many manufacturers-and apparently the med- ical profession is to get it for nothing.-(From The Journal A. M. A., Aug. 6, 1910.) Coblenz Not With Medical Research Corporation To the Editor:-In one of the summer numbers of The Journal (Aug. 6, 1910, p. 519), there appeared an article relative to the "Medical Research Corporation" ["International Encyclopedia of Ethical Non-Official Pharmaceuticals"] with which I was at that time connected as editor-in-chief. I call attention to the fact that I have severed my connection with this corporation. V. Coblenz, New York City. (From The Journal A. M. A., Dec. 10, 1910.) 258 PROPAGANDA. FOR REFORM MEAT EXTRACTS AND MEAT JUICES* Their Composition and Relative Values The Bureau of Chemistry of the Department of Agricul- ture has recently given in Bulletin No. 114 much new and valuable data regarding the commercial meat products. The work contained in this bulletin is practically an elaboration or continuation of that published in The Journal of May 11, 1907, p. 1612. It was taken up to determine the condition and quality of meat preparations in general and from the results obtained to prepare tentative standards for the prep- aration and composition of such meat preparations. The re- sults as well as the methods of analysis of many meat prod- ucts are given, showing the composition and relative value of the various preparations. The comments of many inves- tigators regarding the food value of such products is also a valuable contribution to the knowledge of meat extracts, and will help in deciding the real value of the preparations. The preparations taken up are divided into three general classes: (1) Solid and Fluid Meat Extracts; (2) Meat Juices; (3) Miscellaneous Preparations. For each of these the tentative standards submitted by the Committee on Food Standards of the Association of Official Agricultural Chemists are given along with the tabulated results of the chemical analysis. The preparations examined showed, for the most part, that they conformed to the standards, and only those which are at variance in one or more particulars will be men- tioned in this review. SOLID MEAT EXTRACTS For solid meat extracts the following are the requirements: "Meat extract is the product obtained by extracting meat with boiling water and concentrating the liquid portion by evaporation after removal of fat, and contains not less than 75 per cent, total solids of which not over 27 per cent, is ash and not over 12 per cent, is sodium chlorid (calculated from the total chlorin present), not over 0.6 per cent, is fat and not less than 7 per cent, is nitrogen. The nitrogenous com- pounds contain not less than 40 per cent, of meat bases and not less than 10 per cent, of kreatin." With the above as the standard, several of the solid meat extract preparations examined were not up to grade on one or more points, though in some cases it is true they were * See also the Report of the Council on Pharmacy and Chemistry on "Meat and Beef Juices," page 58. MISCELLANY 259 very slightly below the standard set. The following products were found wanting in some respects and the requirements which they failed to meet are given: "Rex" Brand Beef Extract (Cudahy Packing Co., Omaha) contained 26.50 per cent, water instead of the standard 25 per cent. Extract of Beef Premier (Libby, McNeill & Libby, Chi- cago) contained 30.92 per cent, of ash instead of the standard 27 per cent.; 18.32 per cent, of sodium chlorid (standard, 12 per cent.); 6.02 of nitrogen (standard, 7 per cent.). Beef Extract (Swift & Co., Chicago) contained 13.51 per cent, sodium chlorid (standard, 12 per cent.) ; 6.60 per cent, nitrogen (standard, 7 per cent.). Beef Extract, Coin Special (G. H. Hammond Co., Ham- mond, Ind.) contains 13.25 per cent, of sodium chlorid (stand- ard, 12 per cent.); and 6.86 per cent, nitrogen (standard, 7 per cent.). With these few exceptions, the solid meat extracts were found to comply with the standards given. FLUID MEAT EXTRACTS For fluid meat extract the following standards have been suggested: "Fluid meat extract is identical with meat extract except that it is concentrated to a lower degree and. contains not more than 75 per cent, and not less than 50 per cent, of total solids." According to this standard all excepting one of the fluid meat extracts examined were found to be below grade in one respect, that of solids. The following are preparations ex- amined and the percentage of solids found: Per cent. Concentrated Fluid Beef Extract (Armour & Co., Chicago) 42.25 Meat Juice (Valentine's Meat Juice Co., Richmond,Va.) .42.36 Beef Juice (John Wyeth & Bro., Philadelphia) 41.16 Vigoral (Armour & Co., Chicago)...., 50.06 "Rex" Fluid Beef Extract (Cudahy Packing Co., Omaha) 44.01 Fluid Extract of Beef (Cibilis Co., New York) 35.37 Fluid Beef Jelly (Mcsquera-Julia Food Co., Detroit). .31.03 260 PROPAGANDA FOR REFORM Special notice is directed to the price of some of these prep- arations, which in spite of their large water content, are higher priced than some of the solid meat extracts. MEAT JUICES The following is given as the standard for preparations of meat juice: "Meat juice . . . is the fluid portion of muscle fiber ob- tained by pressure or otherwise, and may be concentrated by evaporation at a temperature below the coagulating point of the soluble proteids. The solids contain not more than 15 per cent, of ash, not more than 2.5 per cent, of sodium chlorid (calculated from the total chlorin present), not more than 4 per cent, nor less than 2 per cent, of phosphoric acid (P2O5), and not less than 12 per cent, of nitrogen. The nitrogenous bodies contain not less than 35 per cent, of coagulable pro- teids and not more than 40 per cent, of meat bases." It is especially noticeable among the meat juices, so called, that none shows any appreciable amount of coagulable pro- teids. Valentine's Meat Juice and Wyeth's Beef Juice, be- sides being below the standard in total solids as fluid ex- tracts, are misbranded when called meat or beef juices, as can readily be seen by comparing the results of the analyses and the standard. Wyeth's Beef Juice is advertised as containing "all the albuminous principles of beef in an active and soluble form" and "in an unaltered form"-two statements that are on the face of them untrue and misleading. To say that all the albuminous principles of meat are present is to say that not only the juice of the meat but all the fiber is present, which evidently is mt true. Then, again, to say that it is present in an unaltered form is far from the facts, for, as is stated on page 18 of the Bulletin: "It appears impracticable to pre- pare a true meat juice for market, as the temperature neces- sary for the preservation of food products in hermetically sealed packages coagulates the proteids and changes the na- ture of the product." On page 55: "When prepared under the best possible conditions a commercial meat extract is, of necessity, in order that it may not spoil, deprived of the greater part of the cpagulabl^ proteids, which constitute the chief nutritious elements of the juice." On examining the tables of analysis, it is seen that Wyeth's Beef Juice contains but 23 per cent, of its total proteids in a coagulable form, while the standard calls for 35 per cent., thus showing it to be no more valuable as a food product MISCELLANY 261 than any other so-called meat juice, the statements of the manufacturers to the contrary notwithstanding. In the case of Valentine's Meat Juice we note a large dis- crepancy between the standard requirements and the results of the government analysis, for instead of the proteid mat- ter containing 35 per cent, in the coagulable form, it contains but 1.6 per cent. These figures show, then, that Valentine's preparation contains practically no coagulable proteids, and since the quantity of these measures the food value of such preparations, the conclusion must be drawn that Valentine's Meat Juice has practically no value as a food and should certainly not be classed as a meat juice. Bovinine, another widely advertised meat preparation, which, according to statements on "The Bovinine Co.'s" letter head, is "a concentrated beef juice" and "the only perfect food in the world," was analyzed and found below the stand- ard set for meat juices, since it contains only 3.38 per cent, of coagulable proteids. Yet in spite of this discrepancy, the manufacturers of Bovinine persist in exploiting it as a food, stating it to be " . . . a concentrated easily assimilable, nitrogenous food," and in another place it is stated that Bovinine "is an ideal food." As it is deficient in coagulable proteids and thus below the requirements as a food, it is misbranded when called a food of any sort, for to quote again the Bulletin, page 55: " . . . meat extracts . . . must not be looked on as representing in any notable degree the food value of the beef or other meat from which they are derived"; and, again: "They are not, however, concentrated foods, having, on the contrary, but comparatively little nutritive value." Taken individually or as a class, meat extracts are not to be considered as foods, and should, therefore, not be adver- tised as such, a conclusion which the government officials have come to and voiced in the conclusion of the Bulletin as follows: VALUE AND LIMITATIONS "It seems to be the consensus of opinion among scientific investigators who have studied this question that the food value of these meat extracts is rather limited, and although they are a source of energy to the body they must not be looked on as representing in any notable degree the food value of the beef or other meat from which they are derived. When prepared under the best possible conditions a commercial meat extract is of necessity, in order that it may not spoil, deprived of the greater part of the coagulable proteids, which 262 PROPAGANDA FOR REFORM constitute the chief nutritious elements of the juice."-(From The Journal A. M. A., Jan. 23, 1908.) PERNICIOUS READY-MADE MIXTURES The sale of reputed abortifacients is too common. The Australian Royal Commission, appointed a few years ago to investigate the nostrum evil, came to the conclusion that pharmaceutical manufacturing houses were largely responsible for the sale of abortifacients. The report of this commission holds that ready-made emmenagogue pills are carried in stock by these houses and it is but a simple matter for irresponsible and criminally inclined persons to embark in the nefarious business of selling them. All that is necessary is for such traffickers to order so many "No. -" pills from a pharmaceutical manufacturing house and use the necessary boxes and labels. The commission referring to the ease with which such products could be obtained, said, regarding the price list of an American manufacturer: "A whole page of the catalogue is filled with a list of these homicidal preparations, offered at low prices. It would hardly accord with public interests to publish a copy of it; but the nature of the drugs, their deplorable consequences, and the absolute fatuity of taking them for the criminal purpose which is the ordinary cause of their sale, cannot be too widely known. . . . They are commonly repacked and sold as secret medicines by per- sons who obtain a living by the traffic, and by phar- macists." The report further holds that it is a common thing for druggists to sell these ready-made pills over the counter as they would sell a Seidlitz powder. While the Australian report mentions only one firm, the criticism applies to most pharmaceutical manufacturing houses making pills or tablets. The following list taken from the catalogue of a pharmaceu- tical manufacturer, is typical of its kind: 39. Amenorrhea. 285. Emmenagogue, "A," Bonjean. Emmenagogue Hobermann (721). 286. Emmenagogue, "B," Hooper. 287. Emmenagogue, "C," No. 4. 288. Emmenagogue, "D," Mutter. Emmenagogue, Mutter, Improved (710) Ergotin, Bonjean, 2 gr. (713). Ergotin, Bonjean, 3 gr. (714). Ergotin, Bonjean, 5 gr. (715). 294. Ergotin Compound, Goodson. MISCELLANY 263 Should the firms who list these preparations be charged with the matter, their defense would be that all these many formulas for "emmenagogue pills" were made at the request of physicians, who prescribed them. While the defense is a weak one, nevertheless we believe that physicians should carefully refrain from prescribing such ready-made formulas. This applies particularly to preparations having therapeu- tically suggestive names, names which the public is quick to understand-or misunderstand-and to recommend for pur- poses not thought of by the prescriber. It is but another illustration of the general objectionableness of "ready-made prescriptions."-(From The Journal A. M. A., June 3, 1911.) PHARMACEUTICAL MANUFACTURERS AND THE GREAT AMERICAN FRAUD At various times we have given more or less complete ac- counts of the prosecutions the United States Government has brought against nostrum exploiters under the Food and Drugs Act. One of the more recent of these, while of comparatively little interest per se is of importance to the medical profession, because of certain elements connected with it. The case is known technically as "Notice of Judgment No. 284" and deals with the "Alleged Misbranding of Danderine." The gist of the case is as follows: Casks of Danderine-a widely advertised "hair tonic"-were shipped in carload lots from Michigan to West Virginia, where the product was bottled, labelled and put in condition to be retailed. Danderine contains a percentage of alcohol which, while given on the labels of the bottles in which it is sold, was not stated on the casks in which the preparation was shipped in bulk. The government sought to confiscate, under the Food and Drugs Act, 65 casks thus shipped because the quantity or proportion of alcohol in the casks was not stated. The Knowlton Danderine Company resisted the confiscation and the court upheld the company's claim. The point in this case which is-or should be-of interest to the medical profession is to be found in the "statement of facts" presented by the Knowlton Danderine Company in its own defense. Here it is said that: "Parke, Davis & Co., who are mentioned in the said libel as shippers . . . are under contract with the said Knowlton Danderine Company . . . to compound the said formula . . ." Elsewhere it is stated: "Parke, Davis & Co. were . . . the manufactur- ing agents, under contract, of the owner, the Danderine Com- pany . . ." PROPAGANDA FOR REFORM 264 This evidently means that Parke, Davis & Co., who are generally supposed to manufacture only "ethical" prepara- tions-proprietary or otherwise-and as such to desire the respect and good wishes of the medical profession, are in the business of furnishing the supplies for nostrum venders. What Danderine is, it is hardly necessary to specify. The widely distributed advertisements of this "hair tonic" nostrum with the slogan: "Danderine Grows Hair and We Can Prove It" are sufficiently well-known to all who read to make a lengthy disquisition on the product unnecessary. It is interesting in this connection to note that according to newspaper dispatches the Danderine Company has absorbed the Sterling Remedy Company, which exploits "Cascarets." Three years ago a physician, who is also a pharmacist, wrote to the Medical World regarding the manufacture of Cas- carets : ". . . I have positive evidence, which I will gladly submit, that P., D. & Co., make all of them [Cascarets], and that they have a contract with the Cascaret people not to make anything similar for any one else." In the circular which comes in the Danderine packages two other "specialties" are advertised: "Neuralgine" for "sick, weak, tired nerves" and "Drake's Palmetto Compound" for "weak stomachs, sluggish livers, disordered kidneys" and vari- ous other derangements of the system. The question naturally arises, are these, too, shipped in casks from Parke, Davis & Co., and merely bottled and labelled in West Virginia? Not that the Danderine case is the first one in which Parke, Davis & Co. have been exposed as manufacturers of nostrum supplies. "Vitaopathy" a method of "treatment" practised by the notorious New York Institute of Physicians and Surgeons in the person of "Prof." Adkin and apparently consisting of "absent treatment" and pills, was finally put out of business by a fraud-order from the post office department. The concern used to advertise: "In Professor Adkin's laboratory, his chemists are daily engaged in extracting the life-and-health-giving principle from rare vege- tables, fruits and plants." "Prof." Adkin had no laboratory; his chemists, according to the government report, were Papke, Davis & Co., from whom he purchased the tablets which formed part of his stock-in- trade of quackery. The Nutriola Company of Chicago was declared fraudulent by the postal authorities and a full account of the methods MISCELLANY 265 of this fake medical concern appeared in The Journal, April, 28, 1906. Nutriola was advertised as: "The greatest Chemical-Medical Preparation ever prepared by the skill of man." "Nutriola and Nature are the only invincible conquerors of dis- eases ever known." The promoter of this scheme was one Edward F. Hanson, who was questioned by the government inspectors regarding the manufacture of the Nutriola nostrum. Quoting from the government report: "Q. Please name the chemists who now manufacture the remedies of the Nutriola Company." "A. Parke, Davis & Company, Detroit; E. L. Patch Manufacturing Company, Stoneham, Mass.; Seabury & Johnson, New York." Not that the course pursued by Parke, Davis & Co. is by any means an exceptional one in the pharmaceutical world. It may be recalled that The Journal has previously referred to the fact that Sharp & Dohme are reported to make or to have made the "Getwell Tablets" for the "patent medicine" con- cern which exploits the nostrum; and that Frederick Stearns & Co. make or did make the widely advertised "cures" Shac and Zymole Trokeys also has been mentioned. That Seabury & Johnson made preparations for a fake medicine concern was brought to light by Mr. Adams in the "Great American Fraud" series. And unquestionably there are many others. The atti- tude taken by such houses seems to be that they are willing to furnish anything in the pharmaceutical line that anyone is willing to pay for, whether it is for legitimate use of the physician or pharmacist or for furthering the business by which the ignorant or gullible sick are humbugged and de- frauded.-(From The Journal A. M. A., July 2, 1910.) SOUR MILK THERAPY The present interest in what may be called "sour milk therapy" in intestinal putrefaction makes the article by P. G. Heinemann in this issue a timely one. While much of the work done on the subject seems to show that lactic acid or lactic ferments possess value in cases of intestinal putrefac- tion, the question has in no sense been settled. Still less has it been proved that the Bacillus bulgaricus as a lactic acid producing organism possesses the advantages in arresting putrefaction which Metchnikoff originally claimed for it. Be- cause of the unpleasant taste produced by the B. bulgaricus, Metchnikoff has urged that the paralactie bacillus (Strepto- 266 PROPAGANDA FOR REFORM coccus lacticus) be used in combination with it. It is there- fore, doubtful which of these two organisms is responsible for any resultant benefit. UNJUSTIFIED CLAIMS Heinemann's experiments show that the claims made for the various preparations on the market for the artificial souring of milk, are not justified in the light of our present knowledge on the subject. The question is not whether lactic acid, lactic acid bacteria, buttermilk or sour milk has any therapeutic value, but, admitting that it has, whether sour milk prepared with commercial cultures possesses any therapeutic advantages over milk naturally soured. The evidence at hand fails to give the artificially soured product any such pre-eminence. Lactobacilline To consider the claims of manufacturers specifically: Lacto- bacilline made by the Lactobacilline Company is said to be prepared according to Metehnikoff's directions. While Metch- nikoff states that yeasts should be absent, as their presence encourages pathogenic bacteria in the digestive tract, Lacto- bacilline contains a yeast. This, too, in spite of the state- ment .of the manufacturers, "it contains no yeast germs," and is "pure and absolutely free from all microbes except the remedial lactobacillus isolated by Prof. Metchnikoff. . . Fermenlactyl Fermenlactyl, which is put on the market by the Anglo- American Pharmacal Company, is very similar in every respect to Lactobacilline. It, too, contains, besides the Bulgarian bacillus, streptococci and yeasts. In the advertising matter microscopic plates are reproduced purporting to show only the "Bulgarian lactic acid bacilli from which Fermenlactyl is pre- pared." As a matter of fact, there are in addition to the B. bulparicus, other bacilli, yeast cells and cocci. The claim of the manufacturers of both Lactobacilline and Fermenlactyl that the Bulgarian bacillus is the chief agent, is true only when conditions are such that the preparation of sour milk can take place at a temperature considerably higher than that of any ordinary room. This is a somewhat difficult matter when the beverage is prepared in a private house. When the milk stands at room temperature the common Streptococcus lac- ticus becomes the predominating organism. This would be no disadvantage if it had not been claimed that the chief virtue of milk soured by these preparations is the presence of the MISCELLANY 267 B. bulgaricus. This organism is said, to lodge permanently in the digestive tract and to give rise to the formation of lactic acid in statu nascendi and thus inhibit the growth of putre- factive bacteria-a statement that lacks scientific proof. Kefilac Kefilac, made by the Kefilac Company, is not a pure culture of lactic acid bacteria and the sour milk prepared with this ferment does not seem to differ materially from ordinary sour milk. Contrary to Metchnikoff's statement that the alcohol contained in the fermented milk of the Bulgarians is of no value, the Kefilac Company states that "through its large portion of water . . . through its carbon dioxid and through its small per cent, of alcohol, Kefilac greatly influ- ences all the vital processes." Like the two preparations pre- viously mentioned, it is a "remedy" for a long list of diseases including cancer of the stomach, rheumatism, etc. Yogurt Yogurt is another preparation of this class made by the Good Health Company, of Battle Creek, Mich. It contains a variety of bacteria and at least one species of yeast so that the composition of the fermented product is very similar to that of the others. The term "meat bacteria" is used in the advertising pamphlet, though what is meant is not altogether clear, since non-sporing bacteria are killed if meat is thor- oughly cooked. The Yogurt tablets are called an "antitoxic ferment"-whatever that may be. The bowels must be kept active, otherwise "Colax"-a "patent medicine" put out by these people-must be used. The number of diseases cured by milk prepared with the Yogurt tablets is enormous. An elaborate list of symptoms is given, some of which may easily be imagined by the anxious layman. In fact, the descriptive matter regarding Yogurt reads very much like a Lydia Pink- ham advertisement. Lactone It is claimed for Lactone tablets by their makers, Parke, Davis & Company, that the soured milk made with them possesses certain advantages over ordinary buttermilk. The statement: "The cream is left in the milk, rendering it of far greater nutritive value" is only partly true. If directions are followed, the milk is diluted with one-third of its volume of water before inoculation and the fat, therefore, is nat- urally reduced to 75 per cent, of the original value in the milk. The fact, too, that the casein, milk sugar and salts 268 PROPAGANDA FOR REFORM of the milk are also reduced to 75 per cent, of the original amount is not stated by the manufacturers. The casein is certainly the most valuable part of the milk and while in ordinary buttermilk only the fat-content is reduced, the other constituents being in nearly the normal proportion, yet in Lactone buttermilk there is more fat but less casein. This is of significance since it is now fairly well established that when cow's milk is used the fat is the cause of infantile digestive troubles rather than the casein. The advertising matter goes on to state: "In the ordinary method of making butter the milk is al- lowed to sour from what accidental bacteria may get into it. Usually the lactic acid germs predominate, but along with these there is always a greater or less number of putrefactive bacteria so that the resulting buttermilk is a mixture of true lactic acid, milk, and putrefactive products." It is difficult to understand why putrefactive bacteria should not be present in the milk when Lactone tablets are used but should be present in the same milk when the tablets are not used. If the purest milk obtainable is used, the putrefactive bac- teria which are always present in the milk-even of the best grade-will not develop because the normal lactic acid bac- teria antagonize them. It is clear that the same dairyman who, by observing cleanliness in his establishment, furnishes a good quality of sweet milk, will observe the same care in handling cream for making butter, and his buttermilk also will be wholesome and clean. USE OF COMMERCIAL "STARTERS" More criticism of a similar nature could be made in regard to the use of commercial preparations for fermenting milk. Where clean-certified-milk can be obtained the use of these various preparations seems unnecessary. Inasmuch as it is not always feasible to obtain certified raw milk, however, boiled or pasteurized milk is to be preferred. It is here that the artificial "starter" is of value. After the first inoculation, the same product can be obtained by in- oculating pasteurized or boiled milk with a small amount of the first lot inoculated, with proper precautions of cleanli- ness. Once started, this process may be continued for a long time without having to renew the "starter." Those who have confidence in the merits of the Bulgarian bacillus of Metchhikoff can procure one of the preparations containing this bacillus and then proceed in the same manner as with MISCELLANY 269 the butter starter. It is entirely unnecessary, if not mis- leading, to use fancy names, as fermenlactyl, lactobacilline, kefilac, lactone or yogurt, this last name suggesting the original Bulgarian fermented milk, containing lactic acid, alcohol, decomposition products of butterfat and of casein, besides a number of microorganisms. A simple name, ap- plicable to all such preparations alike, as for instance, "but- termilk tablets" or "sour milk tablets," seems more rational. The scope of Heinemann's paper and the thoroughness with which he treats the subject make his article an important addition to the literature of lactic acid therapy. The med- ical profession-and the public-is under great obligations to him for his willingness to undertake and carry out these important investigations.-(From The Journal A. M. A., Jan. 30, 1909.) INDEX PAGE Acetanilid Mixtures 9 Acetanilid, Poisoning by 183 Aletris Farinosa 86 Alleotone 145 Alterans, Succus 79 American Druggists Syndicate 205 American Oxidaze Company 205 American Pharmacal Company 2'66 Ammonol 9 Anadol 118 Anasarcin and Anedemin 11 Anasarcin Chemical Company 11 Anderton, T. B 19 Anedemin and Anasarcin 11 Anedemin Chemical Company 11 Angustefolia, Echinacea 39 Antikamnia 9, 148 Antikamnia Chemical Company, The 156 Anusol Hemorrhoidal Suppositories 95 Aromatic Digestive Tablets 97 Arsacetin, Toxicity of 249 Arylarsonates, Toxicity of 247 Aspiro-Lithine 157 Aspirophen 42 Baptisia Tinctoria 87 Basch, Prof. Dr. Med. Chevalier de 202 Battle & Company 223 Beef and Meat Juices 58 Beef Extract , 259 Beef Extract, Coin Special 259 Beef Juice 259 Beef Juice, Wyeth's 62 Bell & Co 70, 239 Benetol 158 Bismuth, Opium and Phenol, Tablets of 127 Blood Purifier, Meyer's 39 Bovinine 63 Bradbury's (Dr.) Eczema Lotion 117 Breitenbach (M. J.) & Company : 226 Bromidia 160 Bromin-Iodin Chemical Company 162 Bromin-Iodin Compound 162 272 PROPAGANDA FOR REFORM PAGE Buffalo Lithia Water 163 Burnham Soluble lodin Company 103 Burnham's Soluble lodin . 102 Burroughs, Wellcome & Co 247 Cactus jGrandiflorus 19 Calcium Chlorophosphate 254 Calcium Chlorhydrophosphate 255 Calmine 165 Camphenol 166 Campho Phenique 24 Campho-Phenique Co '.. . 24 Capudine 166 Capudine Chemical Company 166 Carel, H. C 158 Carnine 64 Cascarans (Bell) 73 Cellaring Co 42 Chamberlain, C. S 40 Chicago Oxygen Co 27 Chlorophosphate 254 Citrocoll 42 Clausel (Henry) & Co 90 Cocillana Compound, Syrup of 245 Cod-Liver Oil Compound, Waterbury's Metabolized 91 Columbus Pharmacal Company 251 Compressed Oxygen 27 Concentrated Fluid Beef Extract 259 Cowles, H. L 205 Cowles Institute, The. 205 Cox Chemical Company 181 Curare 28 Curarin 30 Daniel, J. B 171 Daniel's Concentrated Tincture of Passiflora 74 Daniel's Concentrated Tincture of Passiflora Incarnata 170 Dekofa 171 Digestive Aromatic 100 Digestive Tablets, Aromatic 97 Diastase Ferments 31 Dioscorea Villosa 86 Dodge, J. L 74 Echinacea 38 Ecthol 174 Eczemq. Lotion, Dr. Bradbury's 117 Electropoise 119 Elixir Capu-Hicks 166 Encyclopedia of Ethical Non-Offlcial Pharmaceuticals, The International 255 INDEX 273 PAGE Enteronol 174 Enteronol Company 174 Erpiol (Dr. Schrader) 41 Estill, F 19 Etna Chemical Company 227 Eusoma Pharmaceutical Co 40 Extract of Beef Premier 259 Falkenberg, Fabrik 42 False Unicorn (Helonias) r 42 Ferments, Diastase 31 Fermenlactyl 2G6 Fluid Beef Jelly 259 Fluid Extract of Beef 259 Formurol 42 Fougera & Co 64 Fraser Tablet Company, The... 100 Fraud, Great American and Pharmaceutical Manufacturers. . . . 263 Gardner, R. W. 49 Gardner-Barada Chemical Company ; 137 Gardner's Syrup of Hydriodlc Acid 45 Getsinger, C. E 205 Glycozone . 49 Glyco-Thymoline 180 Goddard, C. H 205 Gonococcide 181 Good Health Company 267 Grisard, A. F. 18 Grisard, B. A 18 Grisard, J. P 18 Grisard, J. W 18 Hance, Bros. & White 76 Headache Cures 182 Helonias-False Unicorn 42 Hemavitae Company 205 Hepatica, Sal 242 Hick's Capudine Cure 166 Hoffmann LaRoche Chemical Works 68 Howard, E 205 Howell (H. B.) & Co., Ltd 203 Howell's Mercol % 203 Hydriodic Acid, Gardner's Syrup of 45 Hydrocine 205 Hydrocine Company 205 "Hydrocyanate of Iron-Tilden" 103 Hydronaphthol 185 Hydrozone 50, 186 274 PROPAGANDA FOR REFORM PAGE Hydrozone and Tongaline 186 Hymosa 106 International Encyclopedia of Ethical Non-Official ' Pharma- ceuticals 255 lodin, Burnham's Soluble 102 lodonucleoid 187 lodovasogen and Vasogen 253 Iridium 189 Iron Tropon 190 Jaroma ....... 191 Jaroma Company 193 John's (Dr.) Tablets 73 Johns Company, L. D 72 Johnson & Johnson 166 Kefilac 267 Kefilac Company 267 Koechl & Co . 65 Koehler's Headache Powders 10 Kutnow, S 196 Kutnow (S.) & Company 196 Kutnow's Powder 194 Labordine 51 Labordine Chemical Company 52 Lactobacilllne 266 Lactobacilline Company 266 Dactone 267 Lactopeptine 5'3 Laine Chemical Company 82 Lehn & Fink , 253 Lilly (Eli) & Co 79 Liquid Life 109 Liquid Nitrous Oxid 55 Littleton, J. M 19 Lithia Water, Buffalo 163 Lucius & Bruning, Meister 65 Luyties Homeopathic Pharmacy Company 109 Lynch, J. J 19 Manola 197 Manola Company, The 197 Marchand, C 50 Mariani & Company 90 Mariani, Vin 89 Marienbad Tablets 202 McKesson and Robbins 157, 246 INDEX 275 PAGE Meat and Beef Juices 58 Meat Extracts 259 Armour's Cudahy's Cibilis' Hammond's Libby's Mosquera-Julia's Swift's Valentine's Wyeth's Meat Extracts and Meat Juices 258 Meat Juice . . ..; 259 Medical Food Company 205 Merck & Company 172 Merck's Caffeinless Coffee 172 Mercol 203 Merrell (William S.) Chemical Co , 41 Metchnikoff, Professor 266 Meyer, H. F. C 39 Meyer's Blood Purifier 39 Micajah & Company 112 Micajah's Medicated Uterine Wafers 112 Migrainin 64 Milk Therapy, Sour 265 Narkine 204 Nitrous Oxid, Liquid 55 Noitol and Anadol 117 Norwich Pharmacal Co . 134, 140 Oleozone 205 Omopon 69 Opium, Phenol and Bismuth, Tablets of 127 Orangeine 10 Oxychlorine 66, 142 Oxychlorine Chemical Company 66, 142 Oxidaze-Oleozone-Hydrocine 205 Oxydase 205 Oxydonor Victory 120 Oxygen, Compressed 27 Oxygenor . 121 Oxygenor King 119 Pancreatin and Pepsin 76 Pantopon 68 Papayans Bell 70 Papine 223 Pas-Avena 225 Pas-Avena Company 225 276 PROPAGANDA FOR REFORM PAGE Parke, D'avis & Co 267 Passiflora and Daniel's Concentrated Tincture of Passiflora... 74 Passiflora Incarnata, Daniel's Concentrated Tincture of 170 Pearson & Company 253 Pepsin and Pancreatin 76 Pepto-Mangan (Gude) 226 Perfected Oxygenor King 121 Pernicious Ready-Made Mixtures 262 Pharmaceutical Manufacturers and the Great American Fraud. 263 Phenacetin, Poisoning by 183 Phenalgin '10, 227 Pheno-Bromate 233 Phenol, Opium and Bismuth, Tablets of 127 Phenolphthalein 234 Phenol Sodique (Hance Bros. & White) 76 Phillips, I. G 19 Platinum Company of America 189 Poisoning by Acetanilid, Antipyrin and Phenacetin 183 Purgen 236 Quinin 150 Quinin Arsenate 81 "Rex" Brand Beef Extract 259 "Rex" Fluid Beef Extract 259 Ready-Made Mixtures, Pernicious 262 Resinol 239 Roberts, C. S 205 Salacetin 10, 239 Sal-Codeia-Bell 241 Sal Hepatica 242 Saliodin 125 Saliodin Chemical Co 125 Sanche, Hercules 120 Sanatogen 243 Schering & Glatz 95 Seabury' & Johnson 185 Strychnin Arsenate 81 Smith, ,C. B 74 Soamin, Toxicity of 247 Sour Milk Therapy 265 Succus Alterans 79 Sulpho-Lythin 82 Suppositories, Anusol Hemorrhoidal 95 Synergia . 100 Syrup of Cocillana Compound 245 T. B. Chemical Company Ill Tablets of Bismuth, Opium and Phenol 127 Tartarlithine 246 INDEX 277 PAGE Tartarlithine Company 246 Tennant, G. C 74 Thialion 87 Tilden Company, The 103, 204 Tongaline 187 Tropon, Iron 190 Tuberculoids 251 Tyree, J. S 84 Tyree's Antiseptic Powder 84 Unguentine 134 Unicorn Root 86 Unicom Root, Wild Yam and Wild Indigo 86 Uricedin 136 Uriseptin 137 Uterine Wafers, Micajah's Medicated 112 Valentine's Meat Juice 64 Vapo-Cresolene 252 Vasogen and lodovasogen 253 Vass Chemical Company 87 Vigoral 259 Vin Mariani 89 Vocor 120 Walker, W. E 18 Walker Pharmacal Company 106 Waterbury Chemical Co 94 Waterbury's Metabolized Cod-Liver Oil Compound 91 Wheeler Chemical Works 117 Wild Indigo 87 Wild Yam 86 Wyeth's Beef Juice 62 Yogurt 267 Zemacol 140 Zyme-oid 142 ADVERTISEMENTS I REPORTS OF THE COUNCIL ON PHARMACY AND CHEMISTRY These are reprints of matter that has appeared from time to time in more or less complete form in The Journal of the American Medical Association. The more technical and scientific parts, which were omitted from or merely abstracted in The Journal, appear in full in this volume. PRICES Volume I (1905 to 1908, inclusive) Cloth cover 75 cents Paper cover 50 cents Volume II (1909) Cloth cover 50 cents Paper cover 25 cents Volume III (1910) Cloth cover (only) 50 cents Sent by mail, prepaid, on receipt of price. REPORTS OF THE CHEMICAL LABORATORY This book contains: (1) "Contributions of the Chem- ical Laboratory of the American Medical Association;" (2) "Chemical Data Contributed to The Journal by the Laboratory;" (3) "Hitherto Unpublished Work of the Laboratory." PRICES Volume I (to Jan. 1, 1909) Paper cover 25 cents Volume 11(1909) Paper cover 25 cents Volume III (1910) Paper cover 25 cents Sent by mail, prepaid, on receipt of price. AMERICAN MEDICAL ASSOCIATION 535 DEARBORN AVENUE, CHICAGO II ADVERTISEMENTS New and Nonofficial Remedies PUBLISHED YEARLY This book contains the descriptions of medicinal substances that have been examined by the Council on Pharmacy and Chemistry of the American Medical Association, and found to comply with the rules of the Council, and have, therefore, been accepted for inclusion in this Annual. The first ten pages of the book are devoted to the presentation of the rules of the Council which form the basis for the work, followed by a discussion and explanation of the reason for the creation of each rule. Physicians are using this handbook to ascertain from an authoritative source the composition and method of preparation, therapeutic action, indications for use, as well as dosage, etc., concerning proprietary products which are worthy of the support of the profession. The Index of Manufacturers indicates in a measure which firms have cooperated with the Council and shows the preparations of these firms which have thus far been approved. PRICES Single Copy, dloth cover $0.50 Single Copy, paper cover 25 Sent by mail, prepaid, on receipt of price. AMERICAN MEDICAL ASSOCIATION 535 DEARBORN AVENUE, CHICAGO ADVERTISEMENTS III The Great American Fraud By Samuel Hopkins Adams Articles on the Nostrum Evil and Quacks. Fully illus- trated. Reprinted from Collier's Weekly. Both series under one cover. Contents: THE NOSTRUM EVIL QUACKS AND QUACKERY I. Introduction. I. The Sure-Cure School II. Peruna and the Bracers II. The Miracle Workers III. Liquozone III. The Specialist Humbug IV. The Subtle Poisons IV. The Scavengers V. Preying on Incurables VI. The Fundamental Fakes Among the subjects discussed are : Preying on the Incur- ables, Miracle Workers, Sure Cure, The Specialist Humbug, the "Patent Medicine" Conspiracy Against the Freedom of the Press, Strictly Confidential, the Treatment Accorded Private Letters by the Nostrum Manufacturers, Peruna, etc., etc. The analyses of many patent medicines are written out in simple language and in several instances are explained by illustration, so that their fraudulent composition will be easily understood and indelibly fixed in the mind of the lay reader. Paper cover. 65 Illustrations. 172 pages. Physicians will find this a splendid brochure to give their patients. ' PRICES Stamps are acceptable for- The following prices do not amounts under one include express or dollar. freight charges. 1 Copy, postpaid $0.10 50 Copies $ 2.00 5 Copies, " 40 100 " 4.00 10 Copies, " 80 500 " 18.00 14 Copies, " 1.00 1000 " 35.00 Cloth Bound Edition We also publish this book bound in red cloth, semilimp- white lettering. This new edition has been issued in per- manent and attractive form so that it can creditably be . placed on the reception room table, where it will be easily accessible for the physician's patients to read. 1 copy, postpaid $0.25 5 copies, postpaid 1.00 Over 5 copies (F. O. B. Chicago), each 18 IV ADVERTISEMENTS The Propaganda for Reform in Proprietary Medicines [Seventh Edition] From time to time The Journal lias printed the reports of the investigations of the Council on Phar- macy and Chemistry, and also other matters relating to the question of proprietary medicines not directly connected with the work of the Council. Requests have been received repeatedly for this or that number of The Journal containing an article on the subject, and as it was impossible to furnish many of the copies asked for, it was thought best to collect most of the matter and issue it in reprint form. Such mixtures as Antikamnia, Phenalgin, Thialion, Salacetin, etc., were subjected to special investigation by the Council and its report published for the informa- tion of the profession. Many of the more widely advertised proprietary products have been analyzed by chemists under the direction of the Council and the reports of their examinations have been published in this pamphlet. After reading the reports published in this Propaganda physicians will realize the value and efficacy of simple scientific combinations of the United States Pharma- copeia and National Formulary preparations as com- pared with ready-made, unstable and inefficient propri- etary articles. PRICES Paper cover 15 cents Cloth Edition 35 cents Sent by mail, prepaid, on receipt of price. AMERICAN MEDICAL ASSOCIATION 535 DEARBORN AVENUE, CHICAGO AD VERT ISE MEE TS V "Nostrums and Quackery" consists chiefly of reprints of those arti- cles that have appeared in The Journal of the American Medical Association. While a number of these articles have been previously reprinted in individual pamphlet form, it has been thought de- N sirable to bring all the matter together in one book : "Nostrums and Quackery" Q is the result. c While this book does not cover so wide a range of subjects as does Mr. qp Adams' "Great American Fraud" series, 1 yet the conperns dealt with are dis- d cussed in greater detail than it was pos- sible, in the nature of the case, for Mr. Adams to do. While most of the exposes are the re- M suit of work done by the American Med- c ical Association, yet advantage has been taken of that done by the Post- office Department through the agency of AND the fraud order and also by the federal and state officials in enforcing the pure q food laws. Some of the subjects are : U Part 1.-Quackery Advertising Special- Drug Cures A ists. Mail-Order Concerns Cancer Cures Mechanical Fakes p Consumption Cures Medical Institutes Deafness Cures K Part 2.-Nostrums £ Asthma Cures Headache Cures Baby Killers Miscellaneous Nos- p Diabetes Cures trums. n Hair Dyes Y Part 3.-Miscellaneous Confidence of Quacks Testimonials This book is issued in a permanent and attractive form, bound in stiff cloth. More than 500 pages. Over 200 illustra- --- tions. PRICE $1.00 AMERICAN MEDICAL ASSOCIATION 535 DEARBORN AVENUE, CHICAGO VI Medical Fakes and Fakers Viavi A concern that, through its agents, tries to convince women that they suffer from "female trouble" for which the company's products are recommended. Dr. Branaman A "cure for deafness" concern in Kansas City, Mo., de- clared fraudulent by the United States postal authorities. Also the fraudulent drug-habit cure of "Dr. J. W. Cob- lentz" of Fort Wayne, Ind. Mrs. Cora B. Miller This was the name under which a man operated a mail- order medical fraud in Kokomo, Ind., for the "cure" of "female trouble." A fraud order was issued against him. Murine Eye Remedy This is a nostrum exploited by two eclectic physicians who also run as a side line a "college" where spectacle fitting is taught by mail. The Bertha C. Day Company A typical mail-order medical fake that traded on the ignor- . ance of suffering women. The Oxydonor and Similar Fakes Worthless pieces of nickel-plated brass pipe alleged to have therapeutic value: The "Electropoise," "Oxydonor," "Oxygenator," "Oxygenor," "Oxypathor" and "Oxytonor." Carnegie University Sells diplomas for $50. With it is affiliated the National Institute of Mechanotherapy. Fake Gall-Stone Cures Fruitola and Mayr's Wonderful Stomach Remedy-two nos- trums sold for the alleged cure of gall-stones. American College of Mechano-Therapy A Chicago concern that professes to teach "osteopathy." "manual manipulation" and "curative mechanics" by mail. Van Bysterveld Medicine Company A fraudulent Grand Rapids, Mich., concern that adver- tised to diagnose all ailments by means of urinalysis. The Interstate Remedy Company A Detroit mail-order medical fake that advertises a "free recipe" as a bait. Those that bite are sent a box of pills- C. O. D., $3.50. Press Agents and Preservatives How the borax trust tries to work the newspapers and mold public opinion through its press agent "H. L. Harris" or "H. H. Dnnvdon." Prices of these ten pamphlets, assorted as desired: One copy, 4 cents; five copies, 15 cents; ten copies, 25 cents; twenty-five copies, 50 cents. All postpaid. Stamps acceptable for amounts under 50 cents. A D VEH TI SEMEN TS A D1 ER T1 SEMEN TS VII Medical Fakes and Fakers Consumption Cure Fakes The ten different preparations discussed in this pamphlet were originally dealt with in The Journal of the American Medical Association. The matter has been somewhat elab- orated, several illustrations added and' the whole reprinted and attractively bound in stiff paper cover. The various fakes dealt with are : Aicsol (Lloyd)* Lung Genuine * Nature's Creation * Yonkermann/s "Tuberculo- J. Lawrence Hill., A.M., zyne" * M.D.* Wilson's Cure Hoff's Cure Oxidaze - Oleozone-Hydro- Sartolin cine * International Institute * [* This matter also appears in individual pamphlet form, price 4 cents.] Cancer Fakes The United States government has, within the last two or three years, investigated a number of concerns exploit- , ing so-called cures for cancer. In practically every case these companies have been declared fraudulent and the use of the United States mails denied them. This pamphlet contains the exposes of the following concerns : Rupert Wells * Dr. and Mrs. Chamlee <6 Co.* G. M. Curry * B. F. Bye ) Drs. Mixer * W. O. Bye - * Toxo-Absorbent Company * L. T. Leach ) [* This matter also appears in individual pamphlet form, price 4 cents.] Medical Institutes Some of the cruelest frauds perpetrated by quacks are those carried on under the name of Medical Institutes. This pamphlet deals with three frauds of this kind- Wisconsin Medical Institute Boston and Bellevue Institute Epileptic Institute Convictions Under the Food and Drugs Act The convictions that the government has obtained against the adulterators of drugs and similar preparations are described technically in official documents known as "Notices of Judgment.'' Ninety-two of these cases are here abstracted in popular form. Prices of these four pamphlets, assorted as desired : One copy, 6 cents; five copies, 25 cents; ten copies, 40 cents; twenty-five copies, 75 cents. Stamps acceptable for amounts under fifty cents. AMERICAN MEDICAL ASSOCIATION 535 DEARBORN AVENUE, CHICAGO